Provider Demographics
NPI:1831901859
Name:BRYAN, PAYTON ASHLEY (SLPA)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:ASHLEY
Last Name:BRYAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 N 37TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5221
Mailing Address - Country:US
Mailing Address - Phone:602-717-8327
Mailing Address - Fax:
Practice Address - Street 1:601 E PIONEER AVE STE 203
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7694
Practice Address - Country:US
Practice Address - Phone:907-435-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174972742355S0801X
AK2335602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant