Individual
JACQUELINE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 OREGON AVE, ALAMOGORDO, NM 88310-5710
(575) 443-6166
(575) 437-0755
Mailing address
PO BOX 553, HI RLS MTN PK, NM 88325-0553
(575) 443-6166
(575) 437-0755
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S1601116
OH
1041C0700X
Clinical Social Worker
Primary
C-11118
NM
Other
Enumeration date
11/17/2016
Last updated
02/09/2024
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