Provider Demographics
NPI:1225281926
Name:BOYLAN, MATTHEW (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OLD MAMARONECK RD
Mailing Address - Street 2:APT. 7M
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1747
Mailing Address - Country:US
Mailing Address - Phone:914-831-7080
Mailing Address - Fax:914-831-7080
Practice Address - Street 1:10 OLD MAMARONECK RD
Practice Address - Street 2:APT. 7M
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1747
Practice Address - Country:US
Practice Address - Phone:914-831-7080
Practice Address - Fax:914-831-7080
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist