Provider Demographics
NPI:1073639183
Name:RUSSELL, ERIN AMELIA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:AMELIA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 FRANKLIN BLVD # 24
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2068
Mailing Address - Country:US
Mailing Address - Phone:541-249-3721
Mailing Address - Fax:
Practice Address - Street 1:328 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2826
Practice Address - Country:US
Practice Address - Phone:541-249-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist