| Doctor Name: | MARY RUSSELL |
| NPI Number: | 1730598814 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 5405 |
| Business Practice Address: | 12170 Cortez Blvd Spring Hill, FL - 346135578 |
| Business Phone Number: | 3525975100 |
| Business Fax Number: | |
| Mailing Address: | 5063 Chamber Ct, SPRING HILL |
| State: | FL |
| Postal Code: | 346091608 |
| Phone Number: | 7273641077 |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2014 |
| NPI Last Update Date: | 10/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 5405 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| 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 |