Individual
SHELLEY RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
343 S KIRKWOOD RD, SUITE 200, SAINT LOUIS, MO 63122-6195
(314) 206-3400
Mailing address
343 S KIRKWOOD RD, SUITE 200, SAINT LOUIS, MO 63122-6195
(314) 206-3400
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/10/2011
Last updated
08/10/2011
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