Most Relevant Information
Provider Data
| NPI Number: | 1003317249 |
| Provider Name: | JAYME RUSSELL |
| Entity Type: | Individual |
| Taxonomy Code: | 2355S0801X |
| Specialty: | Specialist/Technologist |
| License Number: | SLPA8165 |
Most Important Dates
| Enumeration Date: | 02/22/2018 |
| Last Updated: | 02/22/2018 |
Provider Practice Location
25124 N 68TH DR
PEORIA
AZ
853837112
Practice Location Phone/Fax
| Phone: | 5756869605 |
| Fax: |
Provider Mailing Location
25124 N 68TH DR
PEORIA
AZ
853837112
Provider Mailing Phone/Fax
| Phone: | 5756869605 |
| Fax: |