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NPI Code Detail

MEDICARE: MRS. JENNIFER SLACK BOYD MA, CCC-SLP

MEDICARE: MRS. JENNIFER SLACK BOYD MA, CCC-SLP
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
1235Z00000XSpeech-Language Pathologist4576LA

General Provider Information

NPI Number : 1689895922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER SLACK BOYD MA, CCC-SLP
Provider Business Mailing Address
First Line : 10991 COOPER LAKE RD
Second Line :
City : BASTROP
State : LA
Zip : 71220-8412
Country : US
Telephone Number : 318-366-0779
Fax Number :
Provider Business Practice Location Address
First Line : 1123 FORSYTHE AVE
Second Line :
City : MONROE
State : LA
Zip : 71201-4307
Country : US
Telephone Number : 318-340-0724
Fax Number : 318-340-0725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 03/24/2020

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Directions to “ MRS. JENNIFER SLACK BOYD MA, CCC-SLP” Practice Location

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