Provider Demographics
NPI:1518541168
Name:VAN DYK, PAIGE (MA CCC- SLP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:VAN DYK
Suffix:
Gender:F
Credentials:MA CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 80TH ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2691
Mailing Address - Country:US
Mailing Address - Phone:641-485-7917
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist