Provider Demographics
NPI:1861610784
Name:BOYER, NICHOLE AMBER (M A, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:AMBER
Last Name:BOYER
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4531
Mailing Address - Country:US
Mailing Address - Phone:352-351-5560
Mailing Address - Fax:
Practice Address - Street 1:2760 SE 17TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5571
Practice Address - Country:US
Practice Address - Phone:352-817-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2281OtherBC-BS PROV. #