Individual
LINETTE SUE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
950 W MONROE ST STE 600, JACKSON, MI 49202-2173
(517) 945-5632
Mailing address
950 W MONROE ST STE 600, JACKSON, MI 49202-2173
(517) 945-5632
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/14/2017
Last updated
11/19/2020
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