Individual
RUSSELL MARMOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 S ELM ST, APPLETON, WI 54911
(930) 832-5270
(920) 832-5488
Mailing address
401 S ELM ST, APPLETON, WI 54911-5900
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7737123
WI
Other
Enumeration date
07/24/2014
Last updated
07/24/2014
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