Provider Demographics
NPI:1942025242
Name:PAYNE, TRINETTE DENISE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRINETTE
Middle Name:DENISE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-1010
Mailing Address - Country:US
Mailing Address - Phone:901-870-0092
Mailing Address - Fax:
Practice Address - Street 1:130 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-1010
Practice Address - Country:US
Practice Address - Phone:901-870-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty