Provider Demographics
NPI:1881853794
Name:RUSSELL, HILLARY DYAN (MA, RC)
Entity Type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:DYAN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 33RD ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4404
Mailing Address - Country:US
Mailing Address - Phone:425-876-7690
Mailing Address - Fax:
Practice Address - Street 1:7520 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6160
Practice Address - Country:US
Practice Address - Phone:360-716-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055402390200000X
WAPY60280452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8918867Medicare UPIN