Healthcare Provider Details

I. General information

NPI: 1518894948
Provider Name (Legal Business Name): PUZZLE PIECE SPEECG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 17TH ST S
FARGO ND
58103-3934
US

IV. Provider business mailing address

1309 17TH ST S
FARGO ND
58103-3934
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-0908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAIGE NYLAND
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 701-388-0908