Andrea Russell

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ANDREA RUSSELL

Practice address

1200 Jaylee Dr Unit 1
Rigby, ID 83442-5273

Phone

(208) 419-9383

NPI assigned

Apr 10, 2026

Last updated

May 13, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrea RussellNPI 1770342420

Title

Intervention Professional

Phone

(208) 419-9383

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea Russell

  • Developmental Therapist
  • Rigby, ID
  • NPI 1770342420
  NPD Authorized official

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

{
    "created_epoch": "1775779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1104769520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 JAYLEE DR UNIT 1",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425273",
            "telephone_number": "208-419-9383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 JAYLEE DR UNIT 1",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425273",
            "telephone_number": "208-419-9383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA RUSSELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-10",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "INTERVENTION PROFESSIONAL",
        "authorized_official_telephone_number": "208-419-9383"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Rigby, ID
• Providers in Rigby, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.