MEDICARE: JILLIAN RUSSELL LCSW

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	1041C0700X	Clinical Social Worker	8808-C	AR

General Provider Information

NPI Number	:	1851428742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN RUSSELL LCSW

Provider Business Mailing Address
First Line	:	300 S RODNEY PARHAM RD STE 12
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4774
Country	:	US
Telephone Number	:	501-575-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S RODNEY PARHAM RD STE 12
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4774
Country	:	US
Telephone Number	:	501-575-2344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	09/04/2024

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