Provider Demographics
NPI:1720576754
Name:BOYD, CRYSTAL (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 LAKE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8135
Mailing Address - Country:US
Mailing Address - Phone:513-477-5848
Mailing Address - Fax:
Practice Address - Street 1:1835 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1811
Practice Address - Country:US
Practice Address - Phone:513-363-2754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist