Provider Demographics
NPI:1952581084
Name:RUSSELL T. TERRILL AUD
Entity Type:Organization
Organization Name:RUSSELL T. TERRILL AUD
Other - Org Name:REDWOOD AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:707-822-9122
Mailing Address - Street 1:4677 VALLEY EAST BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-0000
Mailing Address - Country:US
Mailing Address - Phone:707-822-9122
Mailing Address - Fax:707-822-1969
Practice Address - Street 1:4677 VALLEY EAST BLVD.
Practice Address - Street 2:SUITE 2
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-0000
Practice Address - Country:US
Practice Address - Phone:707-822-9122
Practice Address - Fax:707-822-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2015231H00000X
CAAU1484231H00000X
CAHA7245237600000X
CAHA7255237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty