MEDICARE: MRS. ALISON MARY RUSSELL MA-SLP

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
1	235Z00000X	Speech-Language Pathologist	SP.13593	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP.13593	OTHER	OH	OHIO STATE LICENSE

General Provider Information

NPI Number	:	1588206569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON MARY RUSSELL MA-SLP

Provider Business Mailing Address
First Line	:	2141 GREENCREST WAY
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-7591
Country	:	US
Telephone Number	:	740-687-7330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2141 GREENCREST WAY
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-7591
Country	:	US
Telephone Number	:	740-687-7330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ MRS. ALISON MARY RUSSELL MA-SLP” Practice Location

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