Organization
ANDREA RUSSELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA RUSSELL (INTERVENTION PROFESSIONAL)
(208) 419-9383
Entity
Organization
Contact information
Practice address
1200 JAYLEE DR UNIT 1, RIGBY, ID 83442-5273
(208) 419-9383
Mailing address
1200 JAYLEE DR UNIT 1, RIGBY, ID 83442-5273
(208) 419-9383
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/10/2026
Last updated
05/13/2026
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