Individual
DR. ANDREA M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
071011112
IL
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
071.011112
IL
Other
Enumeration date
07/07/2023
Last updated
01/09/2024
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