Individual
RUSSELL REESE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
7007 WYOMING BLVD NE, SUITE E-3, ALBUQUERQUE, NM 87109-3987
(505) 884-0112
(505) 828-1385
Mailing address
7007 WYOMING BLVD NE, SUITE E-3, ALBUQUERQUE, NM 87109-3987
(505) 884-0112
(505) 828-1385
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-06600
NM
Other
Enumeration date
07/05/2007
Last updated
10/24/2007
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