Individual
MS. GINA PEASE RUSSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
4610 MADISON AVE, ANDERSON, IN 46013-1316
(765) 641-2037
(765) 641-2041
Mailing address
6110 KENZIE CT, INDIANAPOLIS, IN 46236-7321
(317) 902-7619
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
433653
IN
Other
Enumeration date
10/22/2010
Last updated
10/22/2010
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