Provider Demographics
NPI:1104093244
Name:BOYD, DIANE KLUCINIKAS (MS FAAA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:KLUCINIKAS
Last Name:BOYD
Suffix:
Gender:F
Credentials:MS FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18520 AZALEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855
Mailing Address - Country:US
Mailing Address - Phone:301-758-2797
Mailing Address - Fax:
Practice Address - Street 1:18520 AZALEA DRIVE
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855
Practice Address - Country:US
Practice Address - Phone:301-758-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00233231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist