MEDICARE: MR. MICHAEL RAY PAYNE M.S. 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	SP2899	TN

General Provider Information

NPI Number	:	1407178171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL RAY PAYNE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	25 MAX LANE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2815
Country	:	US
Telephone Number	:	731-541-6572
Fax Number	:	731-541-4436

Provider Business Practice Location Address
First Line	:	25 MAX LANE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2815
Country	:	US
Telephone Number	:	731-541-6572
Fax Number	:	731-541-4436

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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Directions to “ MR. MICHAEL RAY PAYNE M.S. CCC-SLP” Practice Location

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