MEDICARE: RUSSELL GERARD BOYCE M.S. , CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA5840	FL

General Provider Information

NPI Number	:	1235802711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL GERARD BOYCE M.S. , CCC-SLP

Provider Business Mailing Address
First Line	:	3234 40TH WAY S APT C
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-3989
Country	:	US
Telephone Number	:	727-481-2862
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 E KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-3502
Country	:	US
Telephone Number	:	813-272-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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Directions to “ RUSSELL GERARD BOYCE M.S. , CCC-SLP” Practice Location

Language	Start Address	Practice Location

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