Provider Demographics
NPI:1861815474
Name:RUSSO, WENDY S (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:S
Last Name:RUSSO
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 1:1130 FOX DEN TRL
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8310
Mailing Address - Country:US
Mailing Address - Phone:330-797-3900
Mailing Address - Fax:
Practice Address - Street 1:225 IDAHO RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3703
Practice Address - Country:US
Practice Address - Phone:330-797-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1201330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist