Provider Demographics
NPI:1306238258
Name:BOYDEN, JESSICA (LMT)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:BOYDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1527
Mailing Address - Country:US
Mailing Address - Phone:860-694-9945
Mailing Address - Fax:
Practice Address - Street 1:167 BROAD ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3644
Practice Address - Country:US
Practice Address - Phone:860-448-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004377174400000X
AZMT-17303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist