Provider Demographics
NPI:1285443341
Name:BOYNTON, MEGAN (LLMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8925
Mailing Address - Country:US
Mailing Address - Phone:269-286-7030
Mailing Address - Fax:
Practice Address - Street 1:11644 BLUERIDGE ST
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9760
Practice Address - Country:US
Practice Address - Phone:269-806-3598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851112798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker