Provider Demographics
NPI:1760551113
Name:PAYAN, ADRIANNE EISABEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ADRIANNE
Middle Name:EISABEL
Last Name:PAYAN
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 1:4601 DALE ROAD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4684
Mailing Address - Country:US
Mailing Address - Phone:209-735-7040
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE ROAD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-3377
Practice Address - Country:US
Practice Address - Phone:209-735-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15417OtherSPEECH-LANGUAGE PATHOLOGY