| Sue A Russell Phd Pc | |
|
628 7th Ave S Grand Forks ND 58201-4854 | |
| (701) 746-8737 | |
| (701) 746-4763 |
| Full Name | Sue A Russell Phd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 628 7th Ave S, Grand Forks, North Dakota |
| Authorized Official Name and Position | Sue Ann Russell (PRESIDENT) |
| Authorized Official Contact | 7017468737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sue A Russell Phd Pc 628 7th Ave S Grand Forks ND 58201-4854 Ph: (701) 746-8737 | Sue A Russell Phd Pc 628 7th Ave S Grand Forks ND 58201-4854 Ph: (701) 746-8737 |
| NPI Number | 1942371067 |
|---|---|
| Provider Enumeration Date | 11/11/2006 |
| Last Update Date | 02/27/2015 |
| Medicare PECOS PAC ID | 6204838436 |
|---|---|
| Medicare Enrollment ID | O20070131000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942371067 | NPI | - | NPPES |
| 11499 | Other | ND | BLUE CROSS BLUE SHIELD |
| 342553300 | Medicaid | MN | |
| 17418 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 241 (North Dakota) | Primary |
| Provider Name | Sue A Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043382773 PECOS PAC ID: 2567463391 Enrollment ID: I20070123000067 |
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