Individual
JENNIFER LYNN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
694 ISAAC PRUGH WAY, KETTERING, OH 45429-3481
(937) 367-2566
Mailing address
414 OAKWOOD AVE, OAKWOOD, OH 45409-2217
(937) 367-2566
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-5491
OH
Other
Enumeration date
07/10/2024
Last updated
07/10/2024
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