Jackie Lee Russell, LSW, MSW, LMSW

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

M5424 Issued in OR

Practice address

6000 Kanakanak Rd
Dillingham, AK 99576-0130

Phone

(907) 842-5201

Fax

(907) 842-9250

NPI assigned

May 1, 2013

Last updated

May 1, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1104261346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 KANAKANAK RD",
            "city": "DILLINGHAM",
            "state": "AK",
            "postal_code": "995760130",
            "telephone_number": "907-842-5201",
            "fax_number": "907-842-9250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JACKIE",
        "middle_name": "LEE",
        "credential": "LSW, MSW, LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-01",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "M5424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Jeffrey Powers, MD
• Richard Terrence Lee Puckett Jr., N/A
• Brenda Marie Rau, RDH
• Barbara L Riley, MD
• Minnie Lucy Roberts
• Delores Ann Saena
• Safe and Fearfree Environment
• Donald Anthony Salera, DDS
• Kathleen Sando, M.ED.
• Carlos Santos Zivec, RDH

• Case Manager/Care Coordinator in Dillingham, AK
• Providers in Dillingham, AK by specialty
• Case Manager/Care Coordinator in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.