Individual
DR. MARY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
404 W GREEN ST, URBANA, IL 61801-3267
(217) 621-9302
Mailing address
404 W GREEN ST, URBANA, IL 61801-3267
(217) 621-9302
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071.007739
IL
Other
Enumeration date
11/15/2015
Last updated
11/15/2015
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