Individual
ANDREA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1001 N J ST, TACOMA, WA 98403-2125
(253) 830-6242
Mailing address
1001 N J ST, TACOMA, WA 98403-2125
(253) 830-6242
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
128614-121
WI
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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