Provider Demographics
NPI:1306348941
Name:BOYKIN, PAMELA TRAYLOR (MED)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:TRAYLOR
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:TRAYLOR
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:32715 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3113
Mailing Address - Country:US
Mailing Address - Phone:248-427-1310
Mailing Address - Fax:734-629-0453
Practice Address - Street 1:32715 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3113
Practice Address - Country:US
Practice Address - Phone:313-892-0543
Practice Address - Fax:313-892-0543
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist