Provider Demographics
NPI:1417250986
Name:BOYD, KATHRYN INGRID (L/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:INGRID
Last Name:BOYD
Suffix:
Gender:F
Credentials:L/CCC-SLP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:INGRID
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:23 HUSKIE LANE
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-0028
Mailing Address - Country:US
Mailing Address - Phone:518-483-5230
Mailing Address - Fax:
Practice Address - Street 1:42 RIVER ST
Practice Address - Street 2:
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920-2002
Practice Address - Country:US
Practice Address - Phone:518-497-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist