Provider Demographics
NPI:1255937223
Name:RUSS, KRISTEN T (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:T
Last Name:RUSS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5436
Mailing Address - Country:US
Mailing Address - Phone:193-741-6268
Mailing Address - Fax:
Practice Address - Street 1:159 MARBROOK DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5436
Practice Address - Country:US
Practice Address - Phone:937-416-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty