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General NPI Number Information
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NPI Number | 1598757783
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Entity Type | Individual
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Provider Name | ANGELA BOYKIN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 14576 111TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-9300
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Country | US
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Telephone | 559-273-3410
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 SPRING VALLEY DR
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City | HUNTINGTON
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State | WV
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Zip | 25704-9300
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Country | US
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Telephone | 304-429-6675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP6781
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License Number State | MN
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