Individual
COURTNEY ADEL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
200 PATEWOOD DR STE B400, GREENVILLE, SC 29615-6306
(864) 454-4368
(864) 241-9232
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
3965
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01059268
RAILROAD MEDICARE
SC
05
—
SA1249
—
SC
Enumeration date
05/21/2010
Last updated
05/26/2021
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