Individual
KELLY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1813 N MILL ST STE A, NAPERVILLE, IL 60563-4872
(331) 303-8600
Mailing address
8397 W 131ST ST, PALOS PARK, IL 60464-2190
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
152.001292
IL
Other
Enumeration date
12/02/2025
Last updated
12/02/2025
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