Healthcare Provider Details

I. General information

NPI: 1407786312
Provider Name (Legal Business Name): PAIGE MARTELLE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N LAKE ST
FRAZEE MN
56544-4512
US

IV. Provider business mailing address

305 N LAKE ST
FRAZEE MN
56544-4512
US

V. Phone/Fax

Practice location:
  • Phone: 218-334-3181
  • Fax:
Mailing address:
  • Phone: 218-334-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number509354
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: