Healthcare Provider Details

I. General information

NPI: 1972876431
Provider Name (Legal Business Name): WYNNETTE R BOYKIN MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 EATON AVE
HAMILTON OH
45013-1402
US

IV. Provider business mailing address

5971 BEATY LN
FAIRFIELD TOWNSHIP OH
45011-2201
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-7700
  • Fax: 513-896-3600
Mailing address:
  • Phone: 513-512-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2002137-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1451244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: