Provider Demographics
NPI:1184968554
Name:BOYKIN, SUSANNE RACHEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:RACHEL
Last Name:BOYKIN
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 1:103 W GENESEO ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1631
Mailing Address - Country:US
Mailing Address - Phone:303-619-1031
Mailing Address - Fax:
Practice Address - Street 1:103 W GENESEO ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1631
Practice Address - Country:US
Practice Address - Phone:303-619-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0447342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist