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NPI Code Detail

MEDICARE: MRS. NATALIE RUSSELL MA

MEDICARE: MRS. NATALIE RUSSELL MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorWI

General Provider Information

NPI Number : 1184110728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NATALIE RUSSELL MA
Provider Business Mailing Address
First Line : 2233 N 56TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1029
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 106 W SEEBOTH ST STE 101
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-4329
Country : US
Telephone Number : 414-378-5379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2018
Last Update Date : 07/06/2018

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