Individual
MS. ROBERT L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1000 N 92ND ST, CHILD DEVELOPMENT CENTER OF CHW, MILWAUKEE, WI 53226-3533
(414) 805-3666
Mailing address
1000 N 92ND ST, CHILD DEVELOPMENT CENTER OF CHW, MILWAUKEE, WI 53226-3533
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2428
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39139800
—
WI
Enumeration date
05/17/2006
Last updated
07/08/2007
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