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NPI Code Detail

MEDICARE: ADRIENE MARIE BOYD LSW

MEDICARE: ADRIENE MARIE BOYD LSW
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
1104100000XSocial Worker150.118882IL

General Provider Information

NPI Number : 1609567726
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRIENE MARIE BOYD LSW
Provider Business Mailing Address
First Line : 1003 MARTIN LUTHER KING DR
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61701-1429
Country : US
Telephone Number : 888-924-3786
Fax Number :
Provider Business Practice Location Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2023
Last Update Date : 02/04/2026

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Directions to “ ADRIENE MARIE BOYD LSW” Practice Location

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