Provider Demographics
NPI:1831409556
Name:PAGE, STEPHEN W
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:STE 109
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-728-5720
Mailing Address - Fax:231-728-5721
Practice Address - Street 1:1803 WHITES RD
Practice Address - Street 2:STE 1-B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2883
Practice Address - Country:US
Practice Address - Phone:269-373-7585
Practice Address - Fax:269-373-7588
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002101237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist