Healthcare Provider Details

I. General information

NPI: 1487578845
Provider Name (Legal Business Name): PAIGE BENHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR STE 200A
MEDINA OH
44256-3440
US

IV. Provider business mailing address

401 LAFAYETTE RD UNIT 16
MEDINA OH
44256
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax: 330-725-9187
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.2512049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: