Individual
TRACY LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4640 S 144TH ST, TUKWILA, WA 98168-4134
(206) 901-8000
Mailing address
14117 57TH AVE S, TUKWILA, WA 98168-4514
(206) 851-4318
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
SP61040797
WA
235Z00000X
Speech-Language Pathologist
Primary
LL61350516
WA
Other
Enumeration date
01/04/2021
Last updated
11/02/2024
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