Provider Demographics
NPI:1508954439
Name:BOYLE, ELIZABETH SHRYER (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHRYER
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 SELBY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-789-4746
Mailing Address - Fax:651-393-5423
Practice Address - Street 1:1599 SELBY AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105
Practice Address - Country:US
Practice Address - Phone:651-789-4746
Practice Address - Fax:651-393-5423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3254103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN377L5BOOtherBCBS
MN41-1576550OtherBHP
MN080471780OtherMN CARE
MNHP29566OtherHEALTHPARTNERS
MN6145944OtherUBH
MN6145944OtherUBH