Provider Demographics
NPI:1245855881
Name:NOONER, PAIGE JULIA
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:JULIA
Last Name:NOONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:JULIA
Other - Last Name:GOESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11646 KLUTH CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8203
Mailing Address - Country:US
Mailing Address - Phone:708-557-1369
Mailing Address - Fax:
Practice Address - Street 1:1 BLUE DEVIL DR
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-9270
Practice Address - Country:US
Practice Address - Phone:708-258-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL242006223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program