Provider Demographics
NPI:1144507799
Name:RUSSELL, JOHN ROBERT (SPL-A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:SPL-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 W SESAME DR STE C
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8367
Mailing Address - Country:US
Mailing Address - Phone:956-361-5800
Mailing Address - Fax:
Practice Address - Street 1:597 W SESAME DR STE C
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8367
Practice Address - Country:US
Practice Address - Phone:956-361-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant