Individual
JACKIE LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, MSW, LMSW
Contact information
Practice address
6000 KANAKANAK RD, DILLINGHAM, AK 99576-0130
(907) 842-5201
(907) 842-9250
Mailing address
PO BOX 130, DILLINGHAM, AK 99576-0130
(907) 842-5201
(907) 842-9250
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
M5424
OR
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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