Provider Demographics
NPI:1184871030
Name:BOYDSTON, PAIGE S
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:S
Last Name:BOYDSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:S
Other - Last Name:ISENBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11725 S SHANNAN ST
Mailing Address - Street 2:812
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3789
Mailing Address - Country:US
Mailing Address - Phone:816-501-5138
Mailing Address - Fax:
Practice Address - Street 1:1106 N 155TH ST STE B
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-7100
Practice Address - Country:US
Practice Address - Phone:913-662-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016014348103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst