Provider Demographics
NPI:1700209475
Name:BOYL-DAVIS, LISA JO (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:BOYL-DAVIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13115 121ST WAY NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3051
Mailing Address - Country:US
Mailing Address - Phone:425-821-1800
Mailing Address - Fax:425-821-1818
Practice Address - Street 1:13115 121ST WAY NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3051
Practice Address - Country:US
Practice Address - Phone:425-821-1800
Practice Address - Fax:425-821-1818
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604362321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical