Provider Demographics
NPI:1700245040
Name:DAWDY, PAIGE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:DAWDY
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 1:5511 LADUE DR
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2546
Mailing Address - Country:US
Mailing Address - Phone:618-946-6985
Mailing Address - Fax:
Practice Address - Street 1:1043 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6749
Practice Address - Country:US
Practice Address - Phone:184-632-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003537235Z00000X
IL146013201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist