Individual
DR. STEPHANIE SUZANNE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
223 SE DAVIS AVE, BEND, OR 97702-1333
(541) 330-2254
Mailing address
PO BOX 146, BEND, OR 97709-0146
(541) 330-2254
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1525
OR
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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