Individual
AMANDA HARTZ RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
2295 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-7801
(843) 766-7103
(843) 377-4629
Mailing address
2295 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-7801
(843) 766-7103
(843) 377-4629
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A#358
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4142
STATE LICENSE
SC
Enumeration date
08/31/2012
Last updated
08/18/2020
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