Provider Demographics
NPI:1043360647
Name:BOYD, JODY L (LMSW)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:BOYD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:PEKRUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 SEMINOLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3747
Mailing Address - Country:US
Mailing Address - Phone:231-737-1213
Mailing Address - Fax:231-737-1218
Practice Address - Street 1:427 SEMINOLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3747
Practice Address - Country:US
Practice Address - Phone:231-737-1213
Practice Address - Fax:231-737-1218
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010770691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7000027712OtherPRIORITY HEALTH
P23730001Medicare ID - Type Unspecified