CONNIE RUSSELL

KENOSHA, WI
NPI1447691167
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WI  1915-132)
Enumeration Date2013-07-10
Last Update Date2013-07-11
Business Address
CONNIE RUSSELL CSAC
712 55TH ST
KENOSHA, WI 53140-6506
Phone number: 262-842-0538
Mailing Address
CONNIE RUSSELL CSAC
5407 8TH AVE
KENOSHA, WI 53140-3715
Phone number: 262-657-7188
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