Active NPI
Phyllis B Boysen, M.A., CCC-SLP
- Speech-Language Pathologist
- Boise, ID
National Provider Identifier
1164590543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-1257
- Practice address
- 6368 N Portsmouth Ave
Boise, ID 83714-6112 - Phone
- (208) 853-2508
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-1257 | ID | Primary |
Addresses
Primary practice location
6368 N Portsmouth Ave
Boise, ID 83714-6112
Mailing address
6368 N Portsmouth Ave
Boise, ID 83714-6112
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01040219 | Other | ID | ASHA NUMBER |
| SLP-1257 | Other | ID | PROFESSIONAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-1257 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255651200000",
"number": "1164590543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6368 N PORTSMOUTH AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837146112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6368 N PORTSMOUTH AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837146112",
"telephone_number": "208-853-2508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYSEN",
"first_name": "PHYLLIS",
"middle_name": "B",
"credential": "M.A., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2009-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP-1257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA NUMBER",
"identifier": "01040219",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "SLP-1257",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.