Active NPI
Paige Distefano, SLP
- Speech-Language Pathologist
- Madison, WI
National Provider Identifier
1174291330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5360-154
- Practice address
- 2550 University Ave Apt 314
Madison, WI 53705-3805 - Phone
- (718) 564-0057
- NPI assigned
- Sep 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5360-154 | WI | Primary |
Addresses
Primary practice location
2550 University Ave Apt 314
Madison, WI 53705-3805
Mailing address
2550 University Ave Apt 314
Madison, WI 53705-3805
Phone (718) 564-0057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5360-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1174291330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2550 UNIVERSITY AVE APT 314",
"city": "MADISON",
"state": "WI",
"postal_code": "537053805",
"telephone_number": "718-564-0057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2550 UNIVERSITY AVE APT 314",
"city": "MADISON",
"state": "WI",
"postal_code": "537053805",
"telephone_number": "718-564-0057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTEFANO",
"first_name": "PAIGE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-02",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "5360-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.