MEDICARE: ELLA MARGARET 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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1922799691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA MARGARET RUSSELL

Provider Business Mailing Address
First Line	:	21027 ASHLYN CIR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-8108
Country	:	US
Telephone Number	:	704-780-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2106
Country	:	US
Telephone Number	:	185-583-2672
Fax Number	:

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

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “ ELLA MARGARET RUSSELL ” Practice Location

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