Provider Demographics
NPI:1427677285
Name:BOYD, CAMILLE LYNN
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:LYNN
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 MARINA LAKE RD APT 116
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2029
Mailing Address - Country:US
Mailing Address - Phone:203-435-0906
Mailing Address - Fax:
Practice Address - Street 1:3991 MARINA LAKE RD APT 116
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2029
Practice Address - Country:US
Practice Address - Phone:203-435-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002368235Z00000X
VA2202003254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist