Doctor Name: | JILLIAN MARIE RUSSELL |
NPI Number: | 1891060620 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | 6742 |
Business Practice Address: | 1810 Concord Lake Rd Kannapolis, NC - 280836434 |
Business Phone Number: | 7049333781 |
Business Fax Number: | |
Mailing Address: | 8611 Saucercup Ter, HARRISBURG |
State: | NC |
Postal Code: | 280755601 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/13/2012 |
NPI Last Update Date: | 03/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 6742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
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 |