Provider Demographics
NPI:1528359072
Name:BOYD, MIGHEON A (MSA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MIGHEON
Middle Name:A
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4935
Mailing Address - Country:US
Mailing Address - Phone:248-208-0922
Mailing Address - Fax:
Practice Address - Street 1:20100 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4935
Practice Address - Country:US
Practice Address - Phone:248-208-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000455231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist