Individual
PAMELA SULLIVAN RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP, RN
Contact information
Practice address
8420 DELANEY CT, INVER GROVE HEIGHTS, MN 55076-3425
(651) 455-3162
Mailing address
8420 DELANEY COURT, INVER GROVE HEIGHTS, MN 55076
(651) 455-3162
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3039
MN
Other
Enumeration date
11/16/2007
Last updated
03/11/2008
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