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1003931577
RYAN RUSSELL
BENTON, AR
NPI
1003931577
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: AR SP #2073)
Enumeration Date
2007-03-20
Last Update Date
2007-07-08
Business Address
-- RYAN RUSSELL MSSLP.CCC
6701 HIGHWAY 67
BENTON, AR 72015-8909
Phone number: 501-860-0777
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Mailing Address
-- RYAN RUSSELL MSSLP.CCC
1125 CHARLSEA LN
BENTON, AR 72015-2390
Phone number: 501-860-0777
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