Provider Demographics
NPI:1447649595
Name:RUSSELL, KESHIA J (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KESHIA
Middle Name:J
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:KESHIA
Other - Middle Name:J
Other - Last Name:BERRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:1002 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935
Mailing Address - Country:US
Mailing Address - Phone:573-996-3667
Mailing Address - Fax:
Practice Address - Street 1:1002 ELM STREET
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935
Practice Address - Country:US
Practice Address - Phone:573-996-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist