Provider Demographics
NPI:1609858307
Name:PAYNE, BECKY L (MATCC/SLP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MATCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 14 3/4 AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8736
Mailing Address - Country:US
Mailing Address - Phone:715-859-6670
Mailing Address - Fax:
Practice Address - Street 1:2523 14 3/4 AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8736
Practice Address - Country:US
Practice Address - Phone:715-859-6670
Practice Address - Fax:715-859-6669
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1112-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42740100Medicaid
WI216L5LUOtherATRIUM