Provider Demographics
NPI:1477796514
Name:RUSSO, KARRIE ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:ANNE
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:131 W 82ND ST
Mailing Address - Street 2:#8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5551
Mailing Address - Country:US
Mailing Address - Phone:917-885-0855
Mailing Address - Fax:212-202-4997
Practice Address - Street 1:131 W 82ND ST
Practice Address - Street 2:#8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5551
Practice Address - Country:US
Practice Address - Phone:917-885-0855
Practice Address - Fax:212-202-4997
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist