Individual
JESSICA BETH CONNOLLY RUSSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416-2527
(952) 993-3123
Mailing address
4225 NATHAN LN N, PLYMOUTH, MN 55441-1633
(612) 619-3987
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
9519
—
Other
Enumeration date
07/24/2015
Last updated
11/13/2017
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