Active NPI
Erin Russo
- Speech-Language Pathologist
- Valdosta, GA
National Provider Identifier
1710308101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- PCET001888
- Practice address
- 3801 Schroer Road
Valdosta, GA 31605 - Phone
- (229) 244-3552
- Fax
- (229) 244-7030
- NPI assigned
- Jan 2, 2014
- Last updated
- Jul 31, 2014
- Sex
- Female
- Sole proprietor
- No
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 | PCET001888 | GA | Primary |
Addresses
Primary practice location
3801 Schroer Road
Valdosta, GA 31605
Mailing address
3801 Schroer Road
Valdosta, GA 31605
Phone (229) 244-3552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PCET001888 | Other | GA | LICENSE NUMBER |
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 |
|---|---|---|---|
| PCET001888 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1388620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1710308101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3801 SCHROER ROAD",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "31605",
"telephone_number": "229-244-3552",
"fax_number": "229-244-7030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3801 SCHROER ROAD",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "31605",
"telephone_number": "229-244-3552",
"fax_number": "229-244-7030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ERIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-02",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "PCET001888",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "PCET001888",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.