Individual
KATY BOYACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1902 W RIVER OAKS DR, ROUND LAKE, IL 60073-9724
(224) 321-7616
Mailing address
1902 W RIVER OAKS DR, ROUND LAKE, IL 60073-9724
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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