Provider Demographics
NPI:1669095444
Name:DUCHENE, PAIGE MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:DUCHENE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5957
Practice Address - Country:US
Practice Address - Phone:315-724-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00030823235Z00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program