Healthcare Provider Details

I. General information

NPI: 1306131636
Provider Name (Legal Business Name): PAIGE WILSON PHD, LP, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE MISSION PHD, LP, HSPP

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4292
US

IV. Provider business mailing address

3960 PATIENT CARE DR STE 104
LANSING MI
48911-4292
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-9801
  • Fax: 517-887-9826
Mailing address:
  • Phone: 517-887-9801
  • Fax: 517-887-9826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3593
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6286
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301019175
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: