MEDICARE: HOPE K BOYD LCSW

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	1041C0700X	Clinical Social Worker	149.024294	IL

General Provider Information

NPI Number	:	1457074031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE K BOYD LCSW

Provider Business Mailing Address
First Line	:	328 WASHINGTON BLVD APT 1C
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4100
Country	:	US
Telephone Number	:	614-937-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S MARION ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2826
Country	:	US
Telephone Number	:	614-937-3997
Fax Number	:

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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