Provider Demographics
NPI:1447798673
Name:BOYD, JOHN ALBERT
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 EDEN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2996
Mailing Address - Country:US
Mailing Address - Phone:815-978-3629
Mailing Address - Fax:
Practice Address - Street 1:124 EDEN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2996
Practice Address - Country:US
Practice Address - Phone:815-978-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor