MEDICARE: RUSSELL SPEECH THERAPY SERVICES

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1205527496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL SPEECH THERAPY SERVICES

Provider Business Mailing Address
First Line	:	2913 ELM ST
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-6221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 ELM ST
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-6221
Country	:	US
Telephone Number	:	515-971-4588
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MEGAN RUSSELL
Credential	:
Telephone Number	:	515-971-4588

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	08/26/2024

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Directions to “RUSSELL SPEECH THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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