Provider Demographics
NPI:1679330435
Name:BLYDENBURGH, PAIGE (SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BLYDENBURGH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 S COOPER PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2108
Mailing Address - Country:US
Mailing Address - Phone:813-450-7684
Mailing Address - Fax:
Practice Address - Street 1:4520 S COOPER PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2108
Practice Address - Country:US
Practice Address - Phone:813-450-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist