Individual
GINNY BREANN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 BRITTANY LN, LAUREL, MS 39443-7401
(601) 498-9341
Mailing address
17 BRITTANY LANE, LAUREL, MS 39443
(601) 498-9341
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12129712
MS
Other
Enumeration date
02/18/2011
Last updated
06/05/2013
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