| Lori Russell, Llc | |
|
380 Q St Springfield OR 97477-2120 | |
| (541) 726-4118 | |
| Not Available |
| Full Name | Lori Russell, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 380 Q St, Springfield, Oregon |
| Authorized Official Name and Position | Lori Ann Russell (OWNER/THERAPIST) |
| Authorized Official Contact | 5417264118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lori Russell, Llc Po Box 148 Springfield OR 97477-0171 Ph: () - | Lori Russell, Llc 380 Q St Springfield OR 97477-2120 Ph: (541) 726-4118 |
| NPI Number | 1497326409 |
|---|---|
| Provider Enumeration Date | 07/09/2021 |
| Last Update Date | 07/09/2021 |
| Certification Date | 07/09/2021 |
| Medicare PECOS PAC ID | 5597167965 |
|---|---|
| Medicare Enrollment ID | O20210707002592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497326409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Lori Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538331780 PECOS PAC ID: 7214208933 Enrollment ID: I20170728003194 |
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