Provider Demographics
NPI:1073519211
Name:BOYLE, VIRGINIA G (AUD CCC A SLP)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:G
Last Name:BOYLE
Suffix:
Gender:F
Credentials:AUD CCC A SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 W ALOHA DR
Mailing Address - Street 2:STE B
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3374
Mailing Address - Country:US
Mailing Address - Phone:228-255-8889
Mailing Address - Fax:228-255-0890
Practice Address - Street 1:5439 W ALOHA DR
Practice Address - Street 2:STE B
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3374
Practice Address - Country:US
Practice Address - Phone:228-255-8889
Practice Address - Fax:228-255-0890
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA1020231H00000X
MSS1020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS125360700OtherAUDIOLOGY DEPT OF LABOR
MS09015355Medicaid
MS876174OtherHUMANA
MS512I640002OtherMEDICARE
MS1573753OtherCIGNA
MS7636062OtherAETNA
MS09015355Medicaid