Individual
DR. AMY BONIFAY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
2469 E FORT UNION BLVD STE 206, SALT LAKE CITY, UT 84121-3417
(801) 300-6223
Mailing address
2469 EAST FORT UNION BLVD #206, SLC, UT 84121
(801) 300-6223
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4802206-2501
UT
Other
Enumeration date
07/08/2015
Last updated
07/08/2015
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