Provider Demographics
NPI:1265697866
Name:PAIGE, LEIGHANNE PETRENCSIK (SLP)
Entity type:Individual
Prefix:
First Name:LEIGHANNE
Middle Name:PETRENCSIK
Last Name:PAIGE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3926
Mailing Address - Country:US
Mailing Address - Phone:731-599-9896
Mailing Address - Fax:731-599-9922
Practice Address - Street 1:345 HARRISON ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3926
Practice Address - Country:US
Practice Address - Phone:731-599-9896
Practice Address - Fax:731-599-9922
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist