Individual
JOHNNA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW. LCSW
Contact information
Practice address
4304 S BEARFIELD RD, COLUMBIA, MO 65201-9557
(844) 424-3577
Mailing address
4304 S BEARFIELD RD, COLUMBIA, MO 65201-9557
(844) 424-3577
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2020014147
MO
1041C0700X
Clinical Social Worker
Primary
2023011252
MO
Other
Enumeration date
07/10/2020
Last updated
07/12/2023
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