Provider Demographics
NPI:1285108332
Name:AFFANEH, PAIGE NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:AFFANEH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:NICOLE
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2119 MONTOUR STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3265
Mailing Address - Country:US
Mailing Address - Phone:412-403-4766
Mailing Address - Fax:
Practice Address - Street 1:2119 MONTOUR STREET EXT
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3265
Practice Address - Country:US
Practice Address - Phone:412-403-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014623235Z00000X
MD11182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist