Provider Demographics
NPI:1902050313
Name:RUSSELL, ANN C (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 N SCOTTSDALE ROAD, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-2916
Mailing Address - Country:US
Mailing Address - Phone:480-319-1287
Mailing Address - Fax:
Practice Address - Street 1:TOTAL PEDIATRIC THERAPY
Practice Address - Street 2:33755 SCOTTSDALE ROAD, SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-8526
Practice Address - Country:US
Practice Address - Phone:480-319-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04597235Z00000X
AZSLP12477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist