Healthcare Provider Details

I. General information

NPI: 1518012475
Provider Name (Legal Business Name): CINDY SUE BOAZ M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 SAINT MARYS RD
FLOYDS KNOBS IN
47119-8737
US

IV. Provider business mailing address

7030 SAINT MARYS RD
FLOYDS KNOBS IN
47119-8737
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-0939
  • Fax: 812-923-0694
Mailing address:
  • Phone: 812-923-0939
  • Fax: 812-923-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003811A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: