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General NPI Number Information
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NPI Number | 1942371067
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Entity Type | Organization
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Legal Business Name | SUE A RUSSELL PHD PC
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 628 7TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-4854
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Country | US
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Telephone | 701-746-8737
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Fax | 701-746-4763
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Provider Business Mailing Address
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Address Line | 628 7TH AVE S
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City | GRAND FORKS
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State | ND
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Zip | 58201-4854
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Country | US
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Telephone | 701-746-8737
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Fax | 701-746-4763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUE ANN RUSSELL
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Credential | PH.D.
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Telephone | 701-746-8737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 241
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License Number State | ND
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