MEDICARE: CHRISTOPHER NEEL RUSSIE

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	SP61159329	WA

General Provider Information

NPI Number	:	1992669477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER NEEL RUSSIE

Provider Business Mailing Address
First Line	:	PO BOX 274
Second Line	:
City	:	ALLYN
State	:	WA
Zip	:	98524-0274
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 MADRONA DR SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-2752
Country	:	US
Telephone Number	:	360-874-6160
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ CHRISTOPHER NEEL RUSSIE ” Practice Location

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