Provider Demographics
NPI:1003052523
Name:PAYNE, DENIECE MARAGRITA' (MS-SLP, MED)
Entity Type:Individual
Prefix:MS
First Name:DENIECE
Middle Name:MARAGRITA'
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 S FULTON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-0260
Mailing Address - Country:US
Mailing Address - Phone:571-330-8120
Mailing Address - Fax:877-771-3419
Practice Address - Street 1:10105 S FULTON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-0260
Practice Address - Country:US
Practice Address - Phone:571-330-8120
Practice Address - Fax:877-771-3419
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235500000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073788931Medicaid
VA1073788931Medicaid
VA37326Medicare UPIN