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General NPI Number Information
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NPI Number | 1720680556
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Entity Type | Individual
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Provider Name | PAYTEN ANN CRACE
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2703 SE OTIS CORLEY DR STE 11
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City | BENTONVILLE
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State | AR
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Zip | 72712-3414
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Country | US
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Telephone | 479-339-9678
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Fax | 317-520-8200
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Provider Business Mailing Address
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Address Line | 3500 DEPAUW BLVD STE 3070
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-6135
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Country | US
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Telephone | 855-324-0885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 202895
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | AR
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