Provider Demographics
NPI:1699952788
Name:PAYNE, REBECCA ANNE (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:ANNE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:22242 E 63RD ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2009
Mailing Address - Country:US
Mailing Address - Phone:918-630-7334
Mailing Address - Fax:
Practice Address - Street 1:22242 E 63RD ST S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2009
Practice Address - Country:US
Practice Address - Phone:918-630-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist