Provider Demographics
NPI:1124868708
Name:PAYNE, JENNIFER K (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 BARBADOS DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5134
Mailing Address - Country:US
Mailing Address - Phone:618-558-7592
Mailing Address - Fax:
Practice Address - Street 1:131 HILLSBORO AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1621
Practice Address - Country:US
Practice Address - Phone:618-417-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional