Individual
CHRISTINA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, MA STUDENT
Contact information
Practice address
1000 N BROADWAY STE A, PERU, IN 46970
Mailing address
1015 MICHIGAN AVE, LOGANSPORT, IN 46947-1526
(574) 722-5151
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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