Individual
AMBER NICOLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
900 LIBERTY AVE, NEWTON, IL 62448-1808
(618) 783-7529
Mailing address
16521 N STATE HIGHWAY 130, NEWTON, IL 62448-3259
(618) 852-9669
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1230774
IL
Other
Enumeration date
02/25/2025
Last updated
02/25/2025
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