Individual
KAITLYN NICOLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
312 S CAMERON ST, WINCHESTER, VA 22601-4603
(540) 486-4653
(540) 486-4709
Mailing address
312 S CAMERON ST, WINCHESTER, VA 22601-4603
(540) 486-4563
(540) 486-4709
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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