Individual
MRS. JENNIFER PERT RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSLP
Contact information
Practice address
39 LIMERICK RD, ARUNDEL, ME 04046-8158
(207) 391-0331
(207) 985-6703
Mailing address
25 WOODRIDGE DR, STEEP FALLS, ME 04085-6860
(207) 251-1347
(207) 985-6703
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP765
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100667
ANTHEM BCBS
ME
05
—
252300099
—
ME
Enumeration date
01/29/2007
Last updated
09/08/2023
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