Provider Demographics
NPI:1629569975
Name:LINDSTROM, PAIGE JUDE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:JUDE
Last Name:LINDSTROM
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 1:718 BARTON AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2069
Mailing Address - Country:US
Mailing Address - Phone:503-887-8293
Mailing Address - Fax:
Practice Address - Street 1:718 BARTON AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2069
Practice Address - Country:US
Practice Address - Phone:503-887-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer