Provider Demographics
NPI:1881197705
Name:BOYLAN, NATASHA PAULINA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:PAULINA
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 PRECINCT LINE RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3132
Mailing Address - Country:US
Mailing Address - Phone:817-479-7019
Mailing Address - Fax:817-479-7238
Practice Address - Street 1:370 W HIGHWAY 121
Practice Address - Street 2:STE. 105
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:214-222-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist