Provider Demographics
NPI:1184017816
Name:BOYLE, BRITT
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:
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 1:13010 EASTGATE PARK WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3984
Mailing Address - Country:US
Mailing Address - Phone:502-244-1210
Mailing Address - Fax:502-893-1773
Practice Address - Street 1:13010 EASTGATE PARK WAY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3984
Practice Address - Country:US
Practice Address - Phone:502-244-1210
Practice Address - Fax:502-893-1773
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2014-048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100334930Medicaid