Provider Demographics
NPI:1184392888
Name:PAYTON, KRISTI DAWN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:DAWN
Last Name:PAYTON
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 1:702 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-4282
Mailing Address - Country:US
Mailing Address - Phone:806-332-9386
Mailing Address - Fax:
Practice Address - Street 1:607 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-3912
Practice Address - Country:US
Practice Address - Phone:512-533-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist