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General NPI Number Information
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NPI Number | 1083816789
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Entity Type | Individual
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Provider Name | NICOLE S RUSSELL BSW
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3550 SE WOODWARD ST
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City | PORTLAND
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State | OR
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Zip | 97202-1552
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Country | US
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Telephone | 503-813-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 NW SCHMIDT WAY APT. 12
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City | BEAVERTON
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State | OR
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Zip | 97006-4793
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Country | US
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Telephone | 503-998-2715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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