Provider Demographics
NPI:1245434430
Name:PAYNE, EDNA K (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:K
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HOWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3229
Mailing Address - Country:US
Mailing Address - Phone:201-569-3454
Mailing Address - Fax:201-816-3117
Practice Address - Street 1:117 KINDERKAMACK RD STE 107
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1916
Practice Address - Country:US
Practice Address - Phone:201-487-1497
Practice Address - Fax:201-816-3117
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00144300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00144300OtherSPEECH PATHOLOGIST