Connie Russell, CSAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1915-132 Issued in WI

Practice address

712 55TH St
Kenosha, WI 53140-6506

Phone

(262) 842-0538

NPI assigned

Jul 10, 2013

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

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.

• Kenosha Human Development Services, Inc

  • Case Management Agency
  • Kenosha, WI
  • NPI 1942470661
  NPD (past)
• Mathew McCarthy, MD, SC

  • Adult Mental Health Clinic/Center
  • Kenosha, WI
  • NPI 1326179987
  NPD (past)

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373500800000",
    "number": "1447691167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5407 8TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403715",
            "telephone_number": "262-657-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 55TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531406506",
            "telephone_number": "262-842-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CONNIE",
        "credential": "CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "1915-132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Ruffolo, M.D.
• Luis Daniel Ruiz Gonzalez, RDH
• Tara R Rullman, MA
• Kirsten Runnalls, BS, MS, OTR/L
• Michelle M. Runnion, MS, LPC
• Courtney Chaplin Ryan
• Raymond J Rybicki, M.D.
• S&a Ringwala, S.C.
• Lisa Sachs, MSW
• Sacred Art Counseling, LLC

• Addiction (Substance Use Disorder) Counselor in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2013; 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.