Individual
AMY RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2644 RIVA RD, ANNAPOLIS, MD 21401-7427
(410) 222-5000
Mailing address
2644 RIVA RD, ANNAPOLIS, MD 21401-7427
(410) 222-5000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6069
MD
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6069
—
MD
Enumeration date
12/05/2018
Last updated
12/05/2018
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