Individual
DAYLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
902 W MAIN ST, WEST FRANKFORT, IL 62896-2210
(618) 937-6483
Mailing address
1628 E CLARK TRL, HERRIN, IL 62948-4355
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
DR91000698P
IL
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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