Healthcare Provider Details

I. General information

NPI: 1710022298
Provider Name (Legal Business Name): CYNTHIA L BOYKIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 UNITED WAY DRIVE
FREDERIC WI
54837-8938
US

IV. Provider business mailing address

203 UNITED WAY DRIVE
FREDERIC WI
54837-8938
US

V. Phone/Fax

Practice location:
  • Phone: 715-327-4402
  • Fax:
Mailing address:
  • Phone: 715-327-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2413-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: