Provider Demographics
NPI:1093205353
Name:PAIGE, CARLENE SUZANNE (RBT-17-43015)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:SUZANNE
Last Name:PAIGE
Suffix:
Gender:F
Credentials:RBT-17-43015
Other - Prefix:MRS
Other - First Name:CARLENE
Other - Middle Name:S
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARLENE CONNELY
Mailing Address - Street 1:740 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1032
Mailing Address - Country:US
Mailing Address - Phone:630-248-2242
Mailing Address - Fax:
Practice Address - Street 1:740 BIRCHWOOD RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1032
Practice Address - Country:US
Practice Address - Phone:630-248-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-17-43015106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician