Provider Demographics
NPI:1992370712
Name:WHITLOCK, PAIGE ELIZABETH
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:WHITLOCK
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 1:300 TRAILHOUSE LN APT 1125
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3159
Mailing Address - Country:US
Mailing Address - Phone:417-236-5921
Mailing Address - Fax:
Practice Address - Street 1:502 W KEARNEY ST STE 200
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3477
Practice Address - Country:US
Practice Address - Phone:972-454-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist