Provider Demographics
NPI:1376899641
Name:RUSSELL, KIRBY LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIRBY
Middle Name:LEE
Last Name:RUSSELL
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:9040 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4640
Mailing Address - Country:US
Mailing Address - Phone:865-566-6667
Mailing Address - Fax:865-769-0801
Practice Address - Street 1:9040 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4640
Practice Address - Country:US
Practice Address - Phone:865-566-6667
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
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Provider Licenses
StateLicense IDTaxonomies
TN4533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist