Individual
DR. SUE ANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2704 BELMONT RD, GRAND FORKS, ND 58201-7538
(701) 746-8737
(701) 746-4763
Mailing address
2704 BELMONT RD, GRAND FORKS, ND 58201-7538
(701) 746-8737
(701) 746-4763
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
241
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17418
—
ND
Enumeration date
11/15/2006
Last updated
07/09/2007
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