Organization
SUE A RUSSELL PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUE ANN RUSSELL PH.D. (PRESIDENT)
(701) 746-8737
Entity
Organization
Contact information
Practice address
628 7TH AVE S, GRAND FORKS, ND 58201-4854
(701) 746-8737
(701) 746-4763
Mailing address
628 7TH AVE S, GRAND FORKS, ND 58201-4854
(701) 746-8737
(701) 746-4763
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
241
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11499
BLUE CROSS BLUE SHIELD
ND
05
—
17418
—
ND
05
—
342553300
—
MN
Enumeration date
11/11/2006
Last updated
02/27/2015
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