Provider Demographics
NPI:1588799720
Name:LOEB, PAGE (MSW)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:LOEB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W MAGNOLIA ST STE 430
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4354
Mailing Address - Country:US
Mailing Address - Phone:360-738-3411
Mailing Address - Fax:
Practice Address - Street 1:114 W MAGNOLIA ST STE 430
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4354
Practice Address - Country:US
Practice Address - Phone:360-738-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000046581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115000258Medicare ID - Type Unspecified