Provider Demographics
NPI:1073984852
Name:BOYCE, KATLIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATLIN
Middle Name:
Last Name:BOYCE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATLIN
Other - Middle Name:
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18501 ROTUNDA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3891
Mailing Address - Country:US
Mailing Address - Phone:231-349-2722
Mailing Address - Fax:
Practice Address - Street 1:18501 ROTUNDA DR STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3891
Practice Address - Country:US
Practice Address - Phone:313-996-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005205235Z00000X
MA9521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist