Provider Demographics
NPI:1972848257
Name:DEWITT, PAIGE (MSCCCSLP)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:2408 SAGAMORE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1219
Mailing Address - Country:US
Mailing Address - Phone:404-664-1743
Mailing Address - Fax:
Practice Address - Street 1:2408 SAGAMORE HILLS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1219
Practice Address - Country:US
Practice Address - Phone:404-664-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist