Individual
ERIN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3801 SCHROER ROAD, VALDOSTA, GA 31605
(229) 244-3552
(229) 244-7030
Mailing address
3801 SCHROER ROAD, VALDOSTA, GA 31605
(229) 244-3552
(229) 244-7030
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET001888
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCET001888
LICENSE NUMBER
GA
Enumeration date
01/02/2014
Last updated
07/31/2014
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