Provider Demographics
NPI:1548833445
Name:RUSSELL, SYDNEY ALEXIS
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ALEXIS
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2802
Mailing Address - Country:US
Mailing Address - Phone:608-251-6901
Mailing Address - Fax:
Practice Address - Street 1:4 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2802
Practice Address - Country:US
Practice Address - Phone:608-251-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator