| Doctor Name: | JONATHAN DAVID RUSSELL |
| NPI Number: | 1689030124 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | SLP CLINICAL FELLOW |
| License Number: | |
| Business Practice Address: | 250 Fairview Rd Thousand Oaks, CA - 913612456 |
| Business Phone Number: | 8882490707 |
| Business Fax Number: | |
| Mailing Address: | 250 Fairview Rd, THOUSAND OAKS |
| State: | CA |
| Postal Code: | 913612456 |
| Phone Number: | 8882490707 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2016 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |