Provider Demographics
NPI:1578969127
Name:MARTIN, PAIGE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:JOHANNIGMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1408
Mailing Address - Country:US
Mailing Address - Phone:660-476-2108
Mailing Address - Fax:660-476-2104
Practice Address - Street 1:408 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1408
Practice Address - Country:US
Practice Address - Phone:660-476-2108
Practice Address - Fax:660-476-2104
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist