Provider Demographics
NPI:1942519988
Name:PAYNE, LETICIA D (EDS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:F
Credentials:EDS CCC-SLP
Other - Prefix:MS
Other - First Name:LETICIA
Other - Middle Name:D
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS CCC-SLP
Mailing Address - Street 1:4002 HIGHWAY 78 W
Mailing Address - Street 2:SUITE 530-217
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7915
Mailing Address - Country:US
Mailing Address - Phone:404-931-3901
Mailing Address - Fax:
Practice Address - Street 1:4002 HIGHWAY 78 W
Practice Address - Street 2:SUITE 530-217
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7915
Practice Address - Country:US
Practice Address - Phone:404-931-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist