Individual
TABBY JEANE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
808 SILVER SAGE, EVANSVILLE, WY 82636-9532
(307) 251-2459
Mailing address
808 SILVER SAGE, EVANSVILLE, WY 82636-9532
(307) 251-2459
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/02/2011
Last updated
02/02/2011
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