Individual
MYRTLE JEAN BOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3509 N 38TH ST, MILWAUKEE, WI 53216-3409
(414) 517-5144
Mailing address
3509 N 38TH ST, MILWAUKEE, WI 53216-3409
(414) 517-5144
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18203-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18203-130
—
WI
Enumeration date
02/19/2021
Last updated
02/19/2021
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