Provider Demographics
NPI:1427470467
Name:BOYACK, BECKY LYN (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYN
Last Name:BOYACK
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:MORTIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1404 E COPPERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2369
Mailing Address - Country:US
Mailing Address - Phone:801-541-4467
Mailing Address - Fax:
Practice Address - Street 1:1404 E COPPERCREEK RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-2369
Practice Address - Country:US
Practice Address - Phone:801-541-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8785521-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist