Provider Demographics
NPI:1619405115
Name:WYDOLA, PAIGE (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:WYDOLA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5562
Mailing Address - Country:US
Mailing Address - Phone:563-506-4659
Mailing Address - Fax:
Practice Address - Street 1:207 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3195
Practice Address - Country:US
Practice Address - Phone:309-268-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-27
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist