Provider Demographics
NPI:1598450033
Name:CORR, PAIGE R
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:R
Last Name:CORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 S 75TH PLZ APT 201
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4427
Mailing Address - Country:US
Mailing Address - Phone:308-641-7020
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 402D
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2944
Practice Address - Country:US
Practice Address - Phone:402-788-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty