Provider Demographics
NPI:1992496814
Name:BEAUCLAIR, PAIGE JORDAN (SLP-A)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:JORDAN
Last Name:BEAUCLAIR
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 RAUSCH LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1200
Mailing Address - Country:US
Mailing Address - Phone:405-219-6048
Mailing Address - Fax:
Practice Address - Street 1:200 NW 66TH ST STE 925
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8227
Practice Address - Country:US
Practice Address - Phone:405-286-3749
Practice Address - Fax:405-300-0737
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3152355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant