Provider Demographics
NPI:1700485463
Name:DUFRENE, PAIGE JOHNSON (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:JOHNSON
Last Name:DUFRENE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:270 HIGHWAY 3185
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7466
Mailing Address - Country:US
Mailing Address - Phone:985-449-0944
Mailing Address - Fax:985-449-0945
Practice Address - Street 1:270 HIGHWAY 3185
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-7466
Practice Address - Country:US
Practice Address - Phone:985-449-0944
Practice Address - Fax:985-449-0945
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist