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NPI Code Detail

MEDICARE: MS. SANDRA LYNNE BOYLE MS, LPC

MEDICARE: MS. SANDRA LYNNE BOYLE MS, LPC
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
1101YM0800XMental Health CounselorLPC #C1248OR

General Provider Information

NPI Number : 1831249804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA LYNNE BOYLE MS, LPC
Provider Business Mailing Address
First Line : 3719 SW HOOD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4309
Country : US
Telephone Number : 503-869-2430
Fax Number : 503-233-0187
Provider Business Practice Location Address
First Line : 3415 SE POWELL BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3371
Country : US
Telephone Number : 503-869-2430
Fax Number : 503-233-0187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 05/11/2011

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