MEDICARE: MISS SIOBHAN M 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1942790522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SIOBHAN M RUSSELL

Provider Business Mailing Address
First Line	:	1051 TIFFANY S
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1977
Country	:	US
Telephone Number	:	330-629-2955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 TIFFANY S
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1977
Country	:	US
Telephone Number	:	330-629-2955
Fax Number	:

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

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	10/01/2024

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Directions to “ MISS SIOBHAN M RUSSELL ” Practice Location

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