Provider Demographics
NPI:1821451998
Name:WIEDERKEHR, PAIGE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:
Last Name:WIEDERKEHR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 GREENWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2525
Mailing Address - Country:US
Mailing Address - Phone:972-871-1800
Mailing Address - Fax:972-871-1802
Practice Address - Street 1:1231 GREENWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-871-1800
Practice Address - Fax:972-871-1802
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist