Provider Demographics
NPI:1710916374
Name:PAYNE, BRENDA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 SCOTT CT STE A
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-3904
Mailing Address - Country:US
Mailing Address - Phone:319-338-9960
Mailing Address - Fax:319-338-9492
Practice Address - Street 1:373 SCOTT CT STE A
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3904
Practice Address - Country:US
Practice Address - Phone:319-338-9960
Practice Address - Fax:319-338-9492
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACPC0002103TP0016X
IA00854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical