Individual
THOMAS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
10 MISSILE AVE, MINOT, ND 58705-5003
(701) 727-9800
Mailing address
10 MISSILE AVE, MINOT, ND 58705-5003
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14076
MN
Other
Enumeration date
01/06/2009
Last updated
01/06/2009
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