MEDICARE: KATHRYN RUSSO

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	:	1942655642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN RUSSO

Provider Business Mailing Address
First Line	:	2951 SIENA HEIGHTS DR
Second Line	:	524
City	:	HENDERSON
State	:	NV
Zip	:	89052-3872
Country	:	US
Telephone Number	:	740-221-8290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2951 SIENA HEIGHTS DR
Second Line	:	524
City	:	HENDERSON
State	:	NV
Zip	:	89052-3872
Country	:	US
Telephone Number	:	740-221-8290
Fax Number	:

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

Provider Enumeration Date	:	04/30/2016
Last Update Date	:	04/30/2016

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Directions to “ KATHRYN RUSSO ” Practice Location

Language	Start Address	Practice Location

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