Healthcare Provider Details

I. General information

NPI: 1184440398
Provider Name (Legal Business Name): PAIGE ZALEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N STADIUM BLVD APT 35
COLUMBIA MO
65203-8161
US

IV. Provider business mailing address

2620 FORUM BLVD STE E
COLUMBIA MO
65203-5454
US

V. Phone/Fax

Practice location:
  • Phone: 417-755-0957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number822465485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: