Individual
MARLA SUE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
8301 STATE LINE ROAD, SUITE 200, KANSAS CITY, MO 64114-2019
(816) 363-5600
(816) 363-5159
Mailing address
8301 STATE LINE ROAD, SUITE 200, KANSAS CITY, MO 64114-2019
(816) 363-5600
(816) 363-5159
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
944
KS
103T00000X
Psychologist
Primary
PY01033
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499071900
—
MO
Enumeration date
07/11/2006
Last updated
05/05/2020
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