Provider Demographics
NPI:1114415429
Name:BOYLES, JANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BOYLES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 OSBORNE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5029
Mailing Address - Country:US
Mailing Address - Phone:405-550-6031
Mailing Address - Fax:
Practice Address - Street 1:2475 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6332
Practice Address - Country:US
Practice Address - Phone:405-447-1991
Practice Address - Fax:405-447-1198
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist