MEDICARE: LESLIE BOYLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-16-24058	IL

General Provider Information

NPI Number	:	1265977003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE BOYLE

Provider Business Mailing Address
First Line	:	1707 W ROSCOE ST
Second Line	:	1
City	:	CHICAGO
State	:	IL
Zip	:	60657-7215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 W ROSCOE ST
Second Line	:	1
City	:	CHICAGO
State	:	IL
Zip	:	60657-7215
Country	:	US
Telephone Number	:	402-297-2238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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Directions to “ LESLIE BOYLE ” Practice Location

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