Provider Demographics
NPI:1083995799
Name:PAYNE, JENNY BROOKE (MA SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:BROOKE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 ALLVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2907
Mailing Address - Country:US
Mailing Address - Phone:740-408-6063
Mailing Address - Fax:
Practice Address - Street 1:170 MILL ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3036
Practice Address - Country:US
Practice Address - Phone:614-414-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2012047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist