Healthcare Provider Details

I. General information

NPI: 1740826353
Provider Name (Legal Business Name): BRIAN WAYNE JOYCE CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 8TH ST NW
ROCHESTER MN
55901-6817
US

IV. Provider business mailing address

24 8TH ST NW
ROCHESTER MN
55901-6817
US

V. Phone/Fax

Practice location:
  • Phone: 507-289-4031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number113387
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4974-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: