Individual
MS. ANN CAROL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
819 BLOOMINGTON RD, CHAMPAIGN, IL 61820-2101
(217) 356-1558
(217) 366-0160
Mailing address
2905 NORTH MAIN STREET, DECATUR, IL 62526
(217) 877-9117
(217) 877-3077
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
IL
Other
Enumeration date
03/18/2008
Last updated
03/18/2008
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