Provider Demographics
NPI:1376163980
Name:PAYNE, TAYLOR (SLP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2107 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2870
Mailing Address - Country:US
Mailing Address - Phone:630-770-6257
Mailing Address - Fax:
Practice Address - Street 1:1400 BROOKDALE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2126
Practice Address - Country:US
Practice Address - Phone:630-416-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1001648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist