Provider Demographics
NPI:1932163805
Name:BOYLE, DAWN DRISCOLL (MA CCC A)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:DRISCOLL
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:DIANE
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC A
Mailing Address - Street 1:908 RANDALL STREET
Mailing Address - Street 2:
Mailing Address - City:REINBECK
Mailing Address - State:IA
Mailing Address - Zip Code:50669
Mailing Address - Country:US
Mailing Address - Phone:319-345-2044
Mailing Address - Fax:
Practice Address - Street 1:30 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158
Practice Address - Country:US
Practice Address - Phone:641-752-5805
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00562237600000X
IA00838237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0442889Medicaid
Q22604Medicare UPIN
I13006Medicare ID - Type Unspecified