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NPI Profile for KRISTIE A RUSSELL in COBDEN, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X |
| NPI # | 1619165941 |
|
| Status | Active | |
| Credentials | LCPC NCC | |
| Entity | Individual | |
| Enumeration date | 10/11/2007 | |
| Last updated | 10/11/2007 - About 19 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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KRISTIE A RUSSELL
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