MEDICARE: LATARSHA RUSSELL

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	2355S0801X	Speech-Language Assistant	7126	SC

General Provider Information

NPI Number	:	1801746052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATARSHA RUSSELL

Provider Business Mailing Address
First Line	:	513 DONCASTER DR
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2525
Country	:	US
Telephone Number	:	803-201-2090
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 DONCASTER DR
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2525
Country	:	US
Telephone Number	:	803-201-2090
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “ LATARSHA RUSSELL ” Practice Location

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