Provider Demographics
NPI:1235467275
Name:PAYNE, RAQUEL ARIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ARIA
Last Name:PAYNE
Suffix:
Gender:F
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 1:2872 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2335
Mailing Address - Country:US
Mailing Address - Phone:917-501-1447
Mailing Address - Fax:
Practice Address - Street 1:2872 W 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2335
Practice Address - Country:US
Practice Address - Phone:917-501-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist