Provider Demographics
NPI:1669875431
Name:BUSHNELL, PAIGE FORTNEY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:FORTNEY
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-6152
Mailing Address - Country:US
Mailing Address - Phone:816-809-7317
Mailing Address - Fax:
Practice Address - Street 1:6608 RAYTOWN RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5240
Practice Address - Country:US
Practice Address - Phone:816-268-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist