Provider Demographics
NPI:1962500488
Name:PAGE, WENDY MICHELE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELE
Last Name:PAGE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SCHOLL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1571
Mailing Address - Country:US
Mailing Address - Phone:419-756-1133
Mailing Address - Fax:419-756-6544
Practice Address - Street 1:270 STERKEL BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1508
Practice Address - Country:US
Practice Address - Phone:419-756-1133
Practice Address - Fax:419-756-6544
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00702231H00000X
MI1601000049231H00000X
OH1673237600000X
OHA.00702231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
3407897499220OtherANTHEM
OH0110206Medicaid
000000125374OtherANTHEM