Individual
PHYLLIS B BOYSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
6368 N PORTSMOUTH AVE, BOISE, ID 83714-6112
(208) 853-2508
Mailing address
6368 N PORTSMOUTH AVE, BOISE, ID 83714-6112
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1257
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01040219
ASHA NUMBER
ID
01
—
SLP-1257
PROFESSIONAL LICENSE
ID
Enumeration date
12/01/2006
Last updated
10/16/2009
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