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General NPI Number Information
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NPI Number | 1144510413
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Entity Type | Organization
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Legal Business Name | STACY PAYNE SPEECH PATHOLOGY, INC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 11965 VENICE BLVD STE 404
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City | LOS ANGELES
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State | CA
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Zip | 90066-3978
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Country | US
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Telephone | 310-562-0187
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Fax | 310-566-7697
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Provider Business Mailing Address
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Address Line | 11965 VENICE BLVD STE 404
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City | LOS ANGELES
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State | CA
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Zip | 90066-3978
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Country | US
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Telephone | 310-562-0187
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Fax | 310-566-7697
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACY PAYNE
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Credential | M.S., CCC-SLP
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Telephone | 310-562-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SP9299
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License Number State | CA
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