Individual
MS. LEIGHA RACHELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 N BARTON ST, SYRACUSE, KS 67878-7185
(620) 521-8987
Mailing address
PO BOX 596, SYRACUSE, KS 67878-0596
(620) 521-8987
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
KS
Enumeration date
11/04/2022
Last updated
11/04/2022
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