Individual
BROOKE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CFY-SLP
Contact information
Practice address
220 FURST ST, LOCK HAVEN, PA 17745-3720
(570) 295-9145
Mailing address
220 FURST ST, LOCK HAVEN, PA 17745-3720
(570) 295-9145
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/05/2017
Last updated
05/05/2017
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