Provider Demographics
NPI:1285324657
Name:PAYNE, CRYSTAL DEWAN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DEWAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HUNGERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4153
Mailing Address - Country:US
Mailing Address - Phone:240-740-5920
Mailing Address - Fax:
Practice Address - Street 1:MCPS SPEECH AND LANGUAGE SERVICES
Practice Address - Street 2:11721 KEMP MILL ROAD
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1722
Practice Address - Country:US
Practice Address - Phone:240-740-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist