Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-11-9372 | CA |
NPI | 1013274372 |
---|---|
Provider Name | Danielle Marie Russell |
First Address | Fountain Valley, CA 92708-6923 |
Second Address | Fountain Valley, CA 92708-6923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 11/04/2012 |