Individual
LAURA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
515 S WOODSCREST DR STE B, BLOOMINGTON, IN 47401-5303
(812) 929-6061
Mailing address
515 S WOODSCREST DR STE B, BLOOMINGTON, IN 47401-5303
(812) 929-6061
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
—
—
Other
Enumeration date
02/14/2021
Last updated
02/14/2021
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