| NPI | 1205691425 |
|---|---|
| Former Name | SHELBY LEEANN PAYNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149026554) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IL 149026554) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2025-08-04 |