Individual
SUSAN M. RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.,C.C.C.
Contact information
Practice address
10749 E 29TH PL, TULSA, OK 74129-7805
(918) 663-7832
Mailing address
10749 E 29TH PL, TULSA, OK 74129-7805
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
383
OK
Other
Enumeration date
08/03/2006
Last updated
07/08/2007
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