Individual
MRS. JULIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
498 WOODS MILL RD, MANCHESTER, MO 63011-4144
(636) 391-9966
(636) 394-4678
Mailing address
9200 WATSON RD, SUITE G101, SAINT LOUIS, MO 63126-1528
(314) 367-5500
(314) 843-9212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2000164424
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149072
BLUE CROSS
MO
01
—
507838
HEALTHLINK
MO
Enumeration date
02/01/2006
Last updated
07/08/2007
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