Individual
MARK RUSSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
319 NW DOGWOOD ST, ISSAQUAH, WA 98027-3216
(425) 373-1315
Mailing address
319 NW DOGWOOD ST, ISSAQUAH, WA 98027-3216
(425) 373-1315
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00002826
WA
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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