Mykayla Russell
NPI #1043925845 in Fort Wayne, Indiana
Provider Information
- NPI Number
- 1043925845
- Entity Type
- Individual
- Name
- Mykayla Russell
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Behavior Technician
- Enumeration Date
- Jan 17, 2023
- Last Updated
- Jan 17, 2023
Practice Location
- Address
- 201 E RUDISILL BLVD STE 100B
- City
- Fort Wayne
- State
- Indiana
- ZIP Code
- 46806-1756
- Phone
- (219) 301-0774
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Technician |
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