Provider Demographics
NPI:1891812756
Name:RUSSELL, ERIKA S (MS, CCC-SLP, MED)
Entity Type:Individual
Prefix:MISS
First Name:ERIKA
Middle Name:S
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 S CUSTER RD APT 3904
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-6228
Mailing Address - Country:US
Mailing Address - Phone:972-940-1235
Mailing Address - Fax:
Practice Address - Street 1:1231 GREENWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-7530
Practice Address - Country:US
Practice Address - Phone:972-871-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114979OtherLICENSE- SPEECH LANGUAGE PATHOLOGIST