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General NPI Number Information
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NPI Number | 1396538112
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Entity Type | Individual
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Provider Name | PAIGE ELIZABETH WOOLDRIDGE
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Gender | Female
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Dates
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Enumeration Date | 05/24/2025
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Last Update Date | 05/24/2025
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Provider Practice Location Address
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Address Line | 3482 MCCLURE AVE
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-4164
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Country | US
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Telephone | 765-838-3547
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Fax |
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Provider Business Mailing Address
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Address Line | 10716 RADFORD CT
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City | FORT WAYNE
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State | IN
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Zip | 46845-1696
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Country | US
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Telephone | 260-435-9984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1349122
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License Number State | IN
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