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General NPI Number Information
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NPI Number | 1528343522
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Entity Type | Individual
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Provider Name | SUZANNE K RUSSELL M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 1490 STATE ROUTE 488
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-9308
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Country | US
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Telephone | 315-548-6420
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Fax |
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Provider Business Mailing Address
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Address Line | 3456 COUNTY ROAD 16
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2443
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Country | US
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Telephone | 905-585-0610
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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 | 12112499
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License Number State | NY
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