Provider Demographics
NPI:1053699835
Name:BOYKIN, CYNTHIA A
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:361 166TH ST
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-6216
Mailing Address - Country:US
Mailing Address - Phone:773-301-2076
Mailing Address - Fax:708-862-0458
Practice Address - Street 1:361 166TH ST
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-6216
Practice Address - Country:US
Practice Address - Phone:773-301-2076
Practice Address - Fax:708-862-0458
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist