Individual
MRS. DEBRA LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1507 NE 122ND AVE, PORTLAND, OR 97230
(971) 806-1436
Mailing address
1507 NE 122ND AVE, PORTLAND, OR 97230-1911
(971) 806-1436
(503) 230-8884
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
0000311
OR
Other
Enumeration date
05/02/2008
Last updated
06/11/2018
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