Provider Demographics
NPI:1710538871
Name:FLANAGAN, PAIGE LORRAINE (MS, LPC, NCC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:LORRAINE
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4852
Mailing Address - Country:US
Mailing Address - Phone:414-248-7613
Mailing Address - Fax:
Practice Address - Street 1:251 W BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4852
Practice Address - Country:US
Practice Address - Phone:262-477-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4341-226101YP2500X
WI7935-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional