Provider Demographics
NPI:1770647026
Name:BOYLES, JERROLD L (EDD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:L
Last Name:BOYLES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 REED HARTMAN HWY
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2825
Mailing Address - Country:US
Mailing Address - Phone:581-379-1588
Mailing Address - Fax:513-791-7447
Practice Address - Street 1:10979 REED HARTMAN HWY
Practice Address - Street 2:SUITE 218
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-2825
Practice Address - Country:US
Practice Address - Phone:581-379-1588
Practice Address - Fax:513-791-7447
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0388487Medicaid
OH0388487Medicaid