Provider Demographics
NPI:1265565030
Name:PAYNE, SNOW D (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:SNOW
Middle Name:D
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 1:1820 RIDGEVIEW CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7809
Mailing Address - Country:US
Mailing Address - Phone:536-594-5280
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD
Practice Address - Street 2:SUITE 330
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4770
Practice Address - Country:US
Practice Address - Phone:636-733-3330
Practice Address - Fax:636-733-3332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist