Provider Demographics
NPI:1144472135
Name:RUSSELL, JUDITH G (THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:G
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 NE 109TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4631
Mailing Address - Country:US
Mailing Address - Phone:360-718-7119
Mailing Address - Fax:
Practice Address - Street 1:6313 NE 109TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-4631
Practice Address - Country:US
Practice Address - Phone:360-718-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00044340174400000X
WARC 00044340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC 00044340OtherREGISTERED COUNSELOR