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General NPI Number Information
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NPI Number | 1477962678
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Entity Type | Individual
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Provider Name | ALECIA MARIE RUSSELL ED.D
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Gender | Female
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 1444 SHADY LANE RD
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City | COLUMBUS
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State | OH
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Zip | 43227-2110
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Country | US
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Telephone | 614-365-5391
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Fax | 614-365-5390
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Provider Business Mailing Address
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Address Line | 1444 SHADY LANE RD
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City | COLUMBUS
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State | OH
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Zip | 43230
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Country | US
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Telephone | 614-365-5391
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Fax | 614-365-5390
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | CL1010787
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License Number State | OH
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