Provider Demographics
NPI:1447424171
Name:PAYNE, SHELLEY HILL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:HILL
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 1:1600 PEMBROKE OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:KY
Mailing Address - Zip Code:42266-9760
Mailing Address - Country:US
Mailing Address - Phone:270-887-7290
Mailing Address - Fax:270-475-9897
Practice Address - Street 1:1600 PEMBROKE OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-9760
Practice Address - Country:US
Practice Address - Phone:270-887-7290
Practice Address - Fax:270-475-9897
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGN174Medicaid