| Doctor Name: | WENDY MARLENE LONG RUSSELL |
| NPI Number: | 1073747606 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | LW00009617 |
| Business Practice Address: | 9040 Reid St Attn: Mchj-clq-c Joint Base Lewis Mcchord, WA - 984311100 |
| Business Phone Number: | 2539682252 |
| Business Fax Number: | 2539683278 |
| Mailing Address: | 9040 Reid St, Attn: Mchj-clq-c JOINT BASE LEWIS MCCHORD |
| State: | WA |
| Postal Code: | 984311100 |
| Phone Number: | 2539682252 |
| Fax Number: | 2539683278 |
| NPI Enumeration Date: | 05/11/2009 |
| NPI Last Update Date: | 07/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LW00009617 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |