Provider Demographics
NPI:1336335819
Name:CLAYBROOK, RUSS (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RUSS
Middle Name:
Last Name:CLAYBROOK
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-4236
Mailing Address - Country:US
Mailing Address - Phone:207-495-2781
Mailing Address - Fax:
Practice Address - Street 1:496 DUNN RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917-4236
Practice Address - Country:US
Practice Address - Phone:207-495-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist