Provider Demographics
NPI:1811763311
Name:BOYD, COLLEEN LYNN (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 EASTGATE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1588
Mailing Address - Country:US
Mailing Address - Phone:509-956-8796
Mailing Address - Fax:
Practice Address - Street 1:2316 EASTGATE ST STE 150
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1588
Practice Address - Country:US
Practice Address - Phone:509-956-8796
Practice Address - Fax:509-529-3147
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC615056511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical