Individual
DR. JESSICA ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DAT, MS, ATC, CSCS
Contact information
Practice address
1851 SCHOETTLER RD, CHESTERFIELD, MO 63017-5597
(636) 230-1756
Mailing address
5806 RIVERFRONT DR, PALMYRA, NJ 08065-2146
(989) 415-2213
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2021013345
MO
2255A2300X
Athletic Trainer
RT005272
PA
Other
Enumeration date
09/24/2013
Last updated
05/28/2021
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