Provider Demographics
NPI:1528322633
Name:BOYD, DANA SUE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:SUE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 SUTTER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2813
Mailing Address - Country:US
Mailing Address - Phone:812-614-1995
Mailing Address - Fax:
Practice Address - Street 1:1923 SUTTER WOODS RD
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2813
Practice Address - Country:US
Practice Address - Phone:812-614-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3246235Z00000X
IN22005118A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist