Provider Demographics
NPI:1831247972
Name:RUSS, HELENE GIZELLE (PHD)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:GIZELLE
Last Name:RUSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W GALER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3332
Mailing Address - Country:US
Mailing Address - Phone:206-283-9637
Mailing Address - Fax:
Practice Address - Street 1:210 W GALER ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3332
Practice Address - Country:US
Practice Address - Phone:206-283-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB32392Medicare ID - Type UnspecifiedPSYCHOLOGIST