Provider Demographics
NPI:1063135077
Name:MAINO, PAIGE ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:MAINO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E STREET RD STE 3D
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7680
Mailing Address - Country:US
Mailing Address - Phone:215-344-2044
Mailing Address - Fax:
Practice Address - Street 1:210 E STREET RD STE 3D
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7680
Practice Address - Country:US
Practice Address - Phone:215-344-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist