Provider Demographics
NPI:1275350613
Name:BOYDEN, KELLY R (RBT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:BOYDEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4393 CALICO DR S APT 205
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8604
Mailing Address - Country:US
Mailing Address - Phone:320-219-1412
Mailing Address - Fax:
Practice Address - Street 1:4215 31ST AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7743
Practice Address - Country:US
Practice Address - Phone:701-478-0221
Practice Address - Fax:701-478-0222
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician