Individual
KELSEY ANNE RUSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
30150 TELEGRAPH RD STE 245, BINGHAM FARMS, MI 48025-4521
(231) 580-5845
Mailing address
32040 VALLEY VIEW ST, FARMINGTON, MI 48336-3257
(231) 580-5845
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361007575
MI
Other
Enumeration date
10/08/2017
Last updated
07/05/2024
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