Provider Demographics
NPI:1154446961
Name:BOYD, CYNTHIA O'HARIS (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:O'HARIS
Last Name:BOYD
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 ANSON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7422
Mailing Address - Country:US
Mailing Address - Phone:803-260-6471
Mailing Address - Fax:
Practice Address - Street 1:576 ANSON DRIVE
Practice Address - Street 2:LAKE CAROLINA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7244
Practice Address - Country:US
Practice Address - Phone:803-865-6045
Practice Address - Fax:803-865-6045
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0776Medicaid