Individual
JENNIFER CAROL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A, CCC-SLP
Contact information
Practice address
121 BAY RIDGE CT, SHELTON, WA 98584-3608
(360) 463-0455
Mailing address
121 BAY RIDGE COURT, SHELTON, WA 98584
(360) 463-0455
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL 00003701
WA
Other
Enumeration date
02/06/2009
Last updated
02/06/2009
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