Healthcare Provider Details

I. General information

NPI: 1013678861
Provider Name (Legal Business Name): TAYLOR ROSE PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

IV. Provider business mailing address

108 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-3915
  • Fax: 320-774-3918
Mailing address:
  • Phone: 320-774-3915
  • Fax: 320-774-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85614
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: