Individual
JERRY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
399 E MAIN ST, COLUMBUS, OH 43215-5384
(614) 355-8550
(614) 355-8593
Mailing address
PO BOX 715194, COLUMBUS, OH 43271-5194
(614) 355-8004
(614) 355-0509
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.0015942
OH
Other
Enumeration date
07/24/2007
Last updated
12/19/2011
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