Provider Demographics
NPI:1891186888
Name:RUSSELL, MARY KATHERINE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40277
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0277
Mailing Address - Country:US
Mailing Address - Phone:251-445-9378
Mailing Address - Fax:251-445-9377
Practice Address - Street 1:5721 USA DR N
Practice Address - Street 2:1119 HAHN
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-445-9378
Practice Address - Fax:251-445-9377
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1142A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist