Provider Demographics
NPI:1710005095
Name:BOYD, VICKI D (PHD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:D
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2755
Mailing Address - Country:US
Mailing Address - Phone:206-285-3755
Mailing Address - Fax:206-285-0501
Practice Address - Street 1:1836 WESTLAKE AVE N
Practice Address - Street 2:SUITE 300B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2755
Practice Address - Country:US
Practice Address - Phone:206-285-3755
Practice Address - Fax:206-285-0501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7037658Medicaid
WA7037658Medicaid