Provider Demographics
NPI:1023624822
Name:RUSSETTE, KATHRIN LEIGH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRIN
Middle Name:LEIGH
Last Name:RUSSETTE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 INTERLAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9414
Mailing Address - Country:US
Mailing Address - Phone:425-890-7462
Mailing Address - Fax:
Practice Address - Street 1:2301 S STEEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8030
Practice Address - Country:US
Practice Address - Phone:855-633-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60316940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist