Individual
ANTHONY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 DAVIS ST, EVANSTON, IL 60201-4431
(312) 404-7225
Mailing address
3244 S WELLS ST, CHICAGO, IL 60616-3620
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/08/2013
Last updated
08/08/2013
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