Provider Demographics
NPI:1972876431
Name:BOYKIN, WYNNETTE R (MSW, LISW-S)
Entity type:Individual
Prefix:MS
First Name:WYNNETTE
Middle Name:R
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 BEATY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2201
Mailing Address - Country:US
Mailing Address - Phone:513-512-2276
Mailing Address - Fax:
Practice Address - Street 1:1165 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1402
Practice Address - Country:US
Practice Address - Phone:513-868-7700
Practice Address - Fax:513-896-3600
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS14512441041C0700X
OHI.2002137-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS1451244Medicaid