Individual
GREGORY PATRICK RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
(623) 486-6000
Mailing address
8203 W ORAIBI DR, PEORIA, AZ 85382-4680
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
Other
Enumeration date
08/14/2009
Last updated
07/21/2022
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