Russell, Connie

Russell, Connie is an individual health care provider with primary practice located at 712 55Th St , Kenosha WI 53140-6506. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Russell, Connie can be contacted via phone (262) 842-0538.

Contact Information

Primary practice address
712 55Th St Kenosha WI 53140-6506
Phone: (262) 842-0538
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1915-132 Wisconsin

Profile Details

NPI number 1447691167
LBN Legal business name Russell, Connie
Credentials CSAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2013
Last updated Jul 11th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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