Physician Compare National (NPI:1851841969)

HEALTHCARE PROVIDER: AMANDA LOUISE RUSSELL LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1851841969
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426473869
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200803001306
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUSSELL
	Individual professional last name
Provider First Name	AMANDA
	Individual professional first name
Provider Middle Name	LOUISE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1315 HWY 2
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	SANDPOINT
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	838642724
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2086106459
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y