Individual
RAESHA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
214 WEST 9TH ST, CLOVIS, NM 88101
(575) 218-1769
Mailing address
214 W 9TH ST, CLOVIS, NM 88101-6510
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/16/2018
Last updated
04/16/2018
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