Healthcare Provider Details

I. General information

NPI: 1659858504
Provider Name (Legal Business Name): JUDY GAYE BOYER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 EDEN GARDENS DR
FENTON MI
48430-9605
US

IV. Provider business mailing address

1418 EDEN GARDENS DR
FENTON MI
48430-9605
US

V. Phone/Fax

Practice location:
  • Phone: 248-515-7024
  • Fax:
Mailing address:
  • Phone: 248-515-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801065004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: