Olivia Russell

Individual provider Active NPI Speech-Language Assistant · Thayer, MO

NPI 1154199693 · NPPES record last updated Dec 14, 2023

Key facts

NPI
1154199693
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Assistant 2355S0801X
Practice address
401 E Walnut St
Thayer, MO 65791-1533
Phone
(417) 264-4600
NPI assigned
Dec 14, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X Yes

Addresses

Primary practice location

401 E Walnut St
Thayer, MO 65791-1533

Mailing address

401 E Walnut St
Thayer, MO 65791-1533

Other providers in Thayer, MO

All providers in Thayer, MO · Speech-Language Assistant in Missouri

Sources for this page

Verify at the official NPI Registry.