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

Organization subpart

No

Name

Andrea RussellNPI 1770342420

Title

Intervention Professional

Phone

(208) 419-9383

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Russell

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 13, 2026.

{
    "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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• All providers in Rigby, ID
• 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.