Active NPI
Ginny Breann Russell
- Speech-Language Pathologist
- Laurel, MS
National Provider Identifier
1700183233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12129712
- Practice address
- 17 Brittany LN
Laurel, MS 39443-7401 - Phone
- (601) 498-9341
- NPI assigned
- Feb 18, 2011
- 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 | 12129712 | MS | Primary |
Addresses
Primary practice location
17 Brittany LN
Laurel, MS 39443-7401
Mailing address
17 Brittany Lane
Laurel, MS 39443
Phone (601) 498-9341
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 |
|---|---|---|---|
| 12129712 | MS | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1700183233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 BRITTANY LANE",
"city": "LAUREL",
"state": "MS",
"postal_code": "39443",
"telephone_number": "601-498-9341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 BRITTANY LN",
"city": "LAUREL",
"state": "MS",
"postal_code": "394437401",
"telephone_number": "601-498-9341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "GINNY",
"middle_name": "BREANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-18",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MS",
"license": "12129712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.