Individual
MS. JAIZANE ALEXIS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 234-0121
Mailing address
5244 W 2ND ST, DAYTON, OH 45417-9044
(937) 818-9506
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S.1903283
OH
1041C0700X
Clinical Social Worker
Primary
I-2405497
OH
Other
Enumeration date
10/02/2018
Last updated
01/03/2025
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