Provider Demographics
NPI:1255475125
Name:BOYD, KELLY HARVEY (LSLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HARVEY
Last Name:BOYD
Suffix:
Gender:F
Credentials:LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-4000
Mailing Address - Country:US
Mailing Address - Phone:804-405-4658
Mailing Address - Fax:
Practice Address - Street 1:300 ADELPHI ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4601
Practice Address - Country:US
Practice Address - Phone:212-437-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005026235Z00000X
NY017306-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist