Provider Demographics
NPI:1629283478
Name:FUNKHOUSER, PAIGE ERIN (MS)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:ERIN
Last Name:FUNKHOUSER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 W TRAIL DUST ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7671
Mailing Address - Country:US
Mailing Address - Phone:501-208-2797
Mailing Address - Fax:
Practice Address - Street 1:3419 N PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4065
Practice Address - Country:US
Practice Address - Phone:479-521-4001
Practice Address - Fax:479-521-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist