MEDICARE: BERRILYN BOYDSTON

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	235Z00000X	Speech-Language Pathologist	43901	TX

General Provider Information

NPI Number	:	1679301725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERRILYN BOYDSTON

Provider Business Mailing Address
First Line	:	67 S HIGLEY RD STE 103-477
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29622 MAHOGANY VIEW LN
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-2398
Country	:	US
Telephone Number	:	806-340-8245
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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Directions to “ BERRILYN BOYDSTON ” Practice Location

Language	Start Address	Practice Location

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