Provider Demographics
NPI:1578694352
Name:BOYD, LISSA LYNNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISSA
Middle Name:LYNNE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9508
Mailing Address - Country:US
Mailing Address - Phone:785-633-5168
Mailing Address - Fax:
Practice Address - Street 1:2701 SW RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1536
Practice Address - Country:US
Practice Address - Phone:785-232-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist