Provider Demographics
NPI:1730976887
Name:PITRA, PAIGE ELLYSE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ELLYSE
Last Name:PITRA
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 N WATER ST APT 407
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1830
Mailing Address - Country:US
Mailing Address - Phone:309-945-2015
Mailing Address - Fax:
Practice Address - Street 1:1511 N WATER ST APT 407
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1830
Practice Address - Country:US
Practice Address - Phone:309-945-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6478154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist