Provider Demographics
NPI:1255680773
Name:JAFFE, RUSSELL LORENZ (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:LORENZ
Last Name:JAFFE
Suffix:
Gender:M
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 1:5 CHAR BEA LN
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3607
Mailing Address - Country:US
Mailing Address - Phone:314-994-0371
Mailing Address - Fax:
Practice Address - Street 1:5 CHAR BEA LN
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3607
Practice Address - Country:US
Practice Address - Phone:314-994-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist