Individual
JONATHAN PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
2327 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 542-7250
Mailing address
5794 LA QUINTA DR., IDAHO FALLS, ID 83401
(208) 681-0682
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-2052
ID
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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