Individual
ELISSA S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
618 PICKENS RD, YAKIMA, WA 98908-1841
(509) 945-6076
Mailing address
618 PICKENS RD, YAKIMA, WA 98908-1841
(509) 945-6076
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG60211057
WA
Other
Enumeration date
02/04/2011
Last updated
04/15/2016
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