Individual
ANGELICA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11982 S MULBERRY CT, JENKS, OK 74037-2181
(539) 777-0940
Mailing address
516 W 147TH PL S, GLENPOOL, OK 74033-4349
(918) 863-6706
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
OK
Other
Enumeration date
04/07/2023
Last updated
09/03/2025
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