Provider Demographics
NPI:1851812507
Name:BOYCE, AMY LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:BOYCE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:ESCAMILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1350 W CENTRE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5302
Mailing Address - Country:US
Mailing Address - Phone:269-324-0301
Mailing Address - Fax:
Practice Address - Street 1:1350 W CENTRE AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5302
Practice Address - Country:US
Practice Address - Phone:269-324-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001016231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851812507OtherBCBSWI
IL1851812507OtherBCBSIL PPO
WI1851812507Medicaid
ILF400500459-510420OtherIL MEDICARE-LAKE COUNTY
ILF400500458-214660OtherIL MEDICARE - MCHENRY COUNTY