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Individual

RYAN RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSSLP.CCC

Contact information

Practice address
6701 HIGHWAY 67, BENTON, AR 72015-8909
(501) 860-0777
Mailing address
1125 CHARLSEA LN, BENTON, AR 72015-2390
(501) 860-0777

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP #2073
AR

Other

Enumeration date
03/20/2007
Last updated
07/08/2007
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