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General NPI Number Information
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NPI Number | 1962173013
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Entity Type | Individual
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Provider Name | KAREN RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 1375 NW MALL ST STE 4
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City | ISSAQUAH
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State | WA
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Zip | 98027-8950
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Country | US
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Telephone | 425-654-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 16705 SE 43RD ST
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City | BELLEVUE
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State | WA
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Zip | 98006-7141
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Country | US
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Telephone | 861-942-5681
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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