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General NPI Number Information
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NPI Number | 1215699962
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Entity Type | Individual
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Provider Name | VICKIE RUSSELL M.S., CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 500 DOWELL ST
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City | MCKINNEY
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State | TX
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Zip | 75071-5086
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Country | US
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Telephone | 469-302-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 9928 NORTHGATE DR
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City | MCKINNEY
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State | TX
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Zip | 75072-2865
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Country | US
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Telephone | 214-676-1767
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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