Provider Demographics
NPI:1356861595
Name:BOYD, LAYNA MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LAYNA
Middle Name:MICHELLE
Last Name:BOYD
Suffix:
Gender:F
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 1:706 OGLESBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6430
Mailing Address - Country:US
Mailing Address - Phone:217-853-9541
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6430
Practice Address - Country:US
Practice Address - Phone:800-773-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14174024OtherN/A