MEDICARE: PAYTON FRICKE ELLIOTT M.ED., 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	2202012318	VA

General Provider Information

NPI Number	:	1326887746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON FRICKE ELLIOTT M.ED., CCC-SLP

Provider Business Mailing Address
First Line	:	4194 DAUPHIN DR
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-9006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 ALTAVISTA AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-6206
Country	:	US
Telephone Number	:	434-825-7117
Fax Number	:

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

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	06/04/2026

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Directions to “ PAYTON FRICKE ELLIOTT M.ED., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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