Provider Demographics
NPI:1528381118
Name:PAYNE, JILL A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
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 1:2947 AVENUE OF THE PARK
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7637
Mailing Address - Country:US
Mailing Address - Phone:270-313-6414
Mailing Address - Fax:
Practice Address - Street 1:3500 VILLA PT
Practice Address - Street 2:SUITE 110
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7825
Practice Address - Country:US
Practice Address - Phone:270-313-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 3140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist