Basic Information
Provider Information
NPI: 1851061790
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORDWAY
FirstName: PAIGE
MiddleName: KIONA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5982 RHODES RD
Address2:  
City: KENT
State: OH
PostalCode: 442408100
CountryCode: US
TelephoneNumber: 3306731347
FaxNumber: 3306783367
Practice Location
Address1: 799 S MAIN ST
Address2:  
City: LIMA
State: OH
PostalCode: 458041519
CountryCode: US
TelephoneNumber: 4192292222
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2021
LastUpdateDate: 09/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X OHY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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