FAWN RUSSELL

EAST MOLINE, IL
NPI1326538638
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: IL  146.015288)
Additional Taxonomies235Z00000X Speech-Language Pathologist,
(Licence: IA  091685)
Enumeration Date2018-05-11
Last Update Date2020-12-31
Business Address
FAWN RUSSELL
490 AVENUE OF THE CITIES
EAST MOLINE, IL 61244-4031
Phone number: 309-796-1251
Mailing Address
FAWN RUSSELL
PO BOX 6255
ROCK ISLAND, IL 61204-6255
Phone number: 414-429-3332