Individual
MS. HEATHER MARIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6140 W EXECUTIVE DR STE B, MEQUON, WI 53092-4499
(888) 754-0398
Mailing address
6250 SPUR RD APT 209, MEQUON, WI 53092-4430
(262) 442-0060
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/27/2024
Last updated
08/27/2024
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