Provider Demographics
NPI:1881212579
Name:FRUIT, PAIGE RACHELLE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:RACHELLE
Last Name:FRUIT
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 1:22659 E DESERT SPOON DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8545
Mailing Address - Country:US
Mailing Address - Phone:612-554-6106
Mailing Address - Fax:
Practice Address - Street 1:22700 S POWER RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4507
Practice Address - Country:US
Practice Address - Phone:480-424-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP12498235Z00000X
AZSLP12498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist