Active NPI
Melissa Russell
- Speech-Language Pathologist
- Du Quoin, IL
National Provider Identifier
1326566985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.006370
- Practice address
- 845 E Jackson St
Du Quoin, IL 62832-3871 - Phone
- (618) 542-2646
- NPI assigned
- Sep 5, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.006370 | IL | Primary |
Addresses
Primary practice location
845 E Jackson St
Du Quoin, IL 62832-3871
Mailing address
13600 Bandyville Rd
Herrin, IL 62948-6514
Phone (618) 521-1118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.006370 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504569600000",
"number": "1326566985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13600 BANDYVILLE RD",
"city": "HERRIN",
"state": "IL",
"postal_code": "629486514",
"telephone_number": "618-521-1118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 E JACKSON ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628323871",
"telephone_number": "618-542-2646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-05",
"last_updated": "2017-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.006370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Du Quoin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.