Individual
BEULAH JOY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1051 N 220 W APT L1051, OREM, UT 84057-5810
(503) 803-8058
Mailing address
1051 N 220 W APT L1051, OREM, UT 84057-5810
(503) 803-8058
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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