Provider Demographics
NPI:1831869080
Name:RUSSELL, JANAE (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 EMERALD DR APT 214
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2109
Mailing Address - Country:US
Mailing Address - Phone:318-773-0285
Mailing Address - Fax:
Practice Address - Street 1:103 EMERALD DR APT 214
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2109
Practice Address - Country:US
Practice Address - Phone:318-773-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist