Provider Demographics
NPI:1205065216
Name:RUSSELL, REBECCA SUZANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 LAKIN DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9152
Mailing Address - Country:US
Mailing Address - Phone:606-931-0236
Mailing Address - Fax:
Practice Address - Street 1:5025 LAKIN DR
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-9152
Practice Address - Country:US
Practice Address - Phone:606-931-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist