Provider Demographics
NPI:1033869060
Name:RUSSELL, JULIA SAIZAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:SAIZAN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LIONEL CT
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3060
Mailing Address - Country:US
Mailing Address - Phone:504-451-2334
Mailing Address - Fax:
Practice Address - Street 1:1200 W 27TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1276
Practice Address - Country:US
Practice Address - Phone:985-892-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist