Provider Demographics
NPI:1881920973
Name:RUSS, JESSICA ANN (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:RUSS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:CRANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:STE 9C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1457
Practice Address - Country:US
Practice Address - Phone:317-621-5713
Practice Address - Fax:317-913-1472
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002440A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200976160Medicaid
IN200976160Medicaid