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NPI Code Detail

MEDICARE: MRS. JO RUSSELL-BROWN M.ED.

MEDICARE:  MRS. JO  RUSSELL-BROWN  M.ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental TherapistJR50930198PIL

General Provider Information

NPI Number : 1093929259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JO RUSSELL-BROWN M.ED.
Provider Business Mailing Address
First Line : 5030 MCREE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2046
Country : US
Telephone Number : 314-776-1300
Fax Number : 314-776-7808
Provider Business Practice Location Address
First Line : 5030 MCREE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2046
Country : US
Telephone Number : 314-776-1300
Fax Number : 314-776-7808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. JO RUSSELL-BROWN M.ED.” Practice Location

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