Provider Demographics
NPI:1841520665
Name:BOYD, LESLIE LYN (LMP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYN
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241-0713
Mailing Address - Country:US
Mailing Address - Phone:360-436-0286
Mailing Address - Fax:
Practice Address - Street 1:360 MT LOOP HWY
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241
Practice Address - Country:US
Practice Address - Phone:360-436-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004792171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor