Individual
MATTHEW DAVID RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ABA
Contact information
Practice address
151 S 4TH ST STE 401, GRAND FORKS, ND 58201-4715
(701) 795-3000
(701) 795-3050
Mailing address
151 S 4TH ST STE 401, GRAND FORKS, ND 58201-4715
(701) 795-3000
(701) 795-3050
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L29
ND
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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