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General NPI Number Information
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NPI Number | 1326631482
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Entity Type | Individual
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Provider Name | ALYSSA JOY RUSSELL M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 2181 AMBLESIDE DR
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City | CLEVELAND
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State | OH
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Zip | 44106-4645
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Country | US
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Telephone | 216-532-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 4404 MAPLETON ST
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City | JAMESTOWN
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State | PA
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Zip | 16134-3662
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Country | US
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Telephone | 724-974-9509
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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 | SP.13995
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL014916
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License Number State | PA
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