Provider Demographics
NPI:1235802711
Name:BOYCE, RUSSELL GERARD (MS , CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:GERARD
Last Name:BOYCE
Suffix:
Gender:M
Credentials:MS , CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 40TH WAY S APT C
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-3989
Mailing Address - Country:US
Mailing Address - Phone:727-481-2862
Mailing Address - Fax:
Practice Address - Street 1:901 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3502
Practice Address - Country:US
Practice Address - Phone:813-272-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist