Mackenzie Russell, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

016695 Issued in OR

Practice address

304 NE Hood Ave
Gresham, OR 97030-7450

Phone

(503) 666-1333

Fax

(503) 666-2444

NPI assigned

Jul 2, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Therapy Services Inc

  • Pediatric Occupational Therapist
  • Gresham, OR
  • NPI 1700842531

  Speech-Language Pathologist

  NPD (past)
• Legacy Salmon Creek Hospital

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1700809829
  NPD (past)

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

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1215554472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 NE HOOD AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307450",
            "telephone_number": "503-666-1333",
            "fax_number": "503-666-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 NE HOOD AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307450",
            "telephone_number": "503-666-1333",
            "fax_number": "503-666-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MACKENZIE",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-02",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "016695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH AND LANGUAGE PATHOLOGY BOARD",
            "identifier": "016695",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David William Rumer, COMS
• Elena Runyon
• Scott Alan Ruplin, MSW
• Benjamin T Russell, DMD
• Jill Gigi Russell, M.S/CCC-SLP
• Tamekio Russell
• Demetria Lavette Rutledge, APRN-C
• Ryan Douglas Glover Armworks Hand Therapy
• Renae Rykaczewski, FNP-C
• Sabr RTH Facility LLC

• Speech-Language Pathologist in Gresham, OR
• Providers in Gresham, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; 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.