Individual
DYLAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
1520 KELLY PL, WALLA WALLA, WA 99362-8607
(509) 575-4084
Mailing address
PO BOX 959, YAKIMA, WA 98907-0959
(509) 575-4084
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111524501
—
WA
Enumeration date
01/13/2016
Last updated
10/20/2023
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