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General NPI Number Information
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NPI Number | 1881212579
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Entity Type | Individual
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Provider Name | PAIGE RACHELLE FRUIT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 22700 S POWER RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4507
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Country | US
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Telephone | 480-424-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 22659 E DESERT SPOON DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8545
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Country | US
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Telephone | 612-554-6106
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | TSLP12498
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP12498
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License Number State | AZ
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