Individual
SARA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC SLP
Contact information
Practice address
135 GOLD STAR BLVD, WORCESTER, MA 01606
(508) 852-0600
(508) 853-1907
Mailing address
630 PLANTATION ST, WORCESTER, MA 01605
(508) 852-0600
(508) 853-1907
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6577
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
TRICARE CHAMPUS
—
05
—
0708925
—
MA
01
—
90920
FALLON COMMUNITY HEALTH P
—
Enumeration date
02/15/2006
Last updated
02/25/2009
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