MEDICARE: RAQUEL ARIA PAYNE MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	018526	NY

General Provider Information

NPI Number	:	1235467275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL ARIA PAYNE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	2872 W 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2335
Country	:	US
Telephone Number	:	917-501-1447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2872 W 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2335
Country	:	US
Telephone Number	:	917-501-1447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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