Provider Demographics
NPI:1942655642
Name:RUSSO, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 SIENA HEIGHTS DR
Mailing Address - Street 2:524
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3872
Mailing Address - Country:US
Mailing Address - Phone:740-221-8290
Mailing Address - Fax:
Practice Address - Street 1:2951 SIENA HEIGHTS DR
Practice Address - Street 2:524
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3872
Practice Address - Country:US
Practice Address - Phone:740-221-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-30
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist