Provider Demographics
NPI:1972013431
Name:RUSSELL, EMILY LUANN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LUANN
Last Name:RUSSELL
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 1:7819 CONSER PL
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2820
Mailing Address - Country:US
Mailing Address - Phone:913-789-9000
Mailing Address - Fax:913-789-9900
Practice Address - Street 1:7819 CONSER PL
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2820
Practice Address - Country:US
Practice Address - Phone:913-789-9000
Practice Address - Fax:913-789-9900
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist