Individual
JENNIFER M. RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
267 GRANT ST, BRIDGEPORT, CT 06610-2805
(203) 384-3000
Mailing address
1415 WASHINGTON BLVD, STAMFORD, CT 06902-2404
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
003894
CT
Other
Enumeration date
10/05/2007
Last updated
10/05/2007
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