Provider Demographics
NPI:1093575177
Name:BOYLE, JACQUELYNN MARIE
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:MARIE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22483 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2635
Mailing Address - Country:US
Mailing Address - Phone:586-212-2765
Mailing Address - Fax:
Practice Address - Street 1:22483 MARINE AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2635
Practice Address - Country:US
Practice Address - Phone:586-212-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103T00000XBehavioral Health & Social Service ProvidersPsychologist