Provider Demographics
NPI:1184317190
Name:BOYUM, SYDNEY JANINE (MASTER'S OF SCIENCE)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JANINE
Last Name:BOYUM
Suffix:
Gender:F
Credentials:MASTER'S OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 BERKELEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7662
Mailing Address - Country:US
Mailing Address - Phone:910-465-9602
Mailing Address - Fax:
Practice Address - Street 1:2012 HAROBI DR STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5161
Practice Address - Country:US
Practice Address - Phone:678-892-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist