Healthcare Provider Details

I. General information

NPI: 1285549584
Provider Name (Legal Business Name): PAIGE VIETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE HESSELBERG

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HAMLIN ST E
WEST SALEM WI
54669-1297
US

IV. Provider business mailing address

405 HAMLIN ST E
WEST SALEM WI
54669-1297
US

V. Phone/Fax

Practice location:
  • Phone: 608-786-1064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001028147
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: