Provider Demographics
NPI:1487372652
Name:PAYNE, D'AJANAE ALEXIS (CCC)
Entity type:Individual
Prefix:
First Name:D'AJANAE
Middle Name:ALEXIS
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E ERIE AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2103
Mailing Address - Country:US
Mailing Address - Phone:440-984-9523
Mailing Address - Fax:
Practice Address - Street 1:2601 POLE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-4303
Practice Address - Country:US
Practice Address - Phone:440-984-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist