Individual
FREDREAKA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 E HUNT HWY, SUITE 103-230, QUEEN CREEK, AZ 85243-6581
(602) 579-7880
Mailing address
530 E HUNT HWY, SUITE 103-230, QUEEN CREEK, AZ 85243-6581
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
11/27/2007
Last updated
11/27/2007
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