Individual
FAWN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
490 AVENUE OF THE CITIES, EAST MOLINE, IL 61244-4031
(309) 796-1251
Mailing address
PO BOX 6255, ROCK ISLAND, IL 61204-6255
(414) 429-3332
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
091685
IA
235Z00000X
Speech-Language Pathologist
Primary
146.015288
IL
Other
Enumeration date
05/11/2018
Last updated
12/31/2020
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