Provider Demographics
NPI:1588206569
Name:RUSSELL, ALISON MARY (MA-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MARY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 GREENCREST WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7591
Mailing Address - Country:US
Mailing Address - Phone:740-687-7330
Mailing Address - Fax:
Practice Address - Street 1:2141 GREENCREST WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-7591
Practice Address - Country:US
Practice Address - Phone:740-687-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.13593OtherOHIO STATE LICENSE