Jessica Elizabeth Russom

NPI #1225864366 in Poplar Bluff, Missouri

Provider Information

NPI Number: 1225864366
Entity Type: Individual
Name: Jessica Elizabeth Russom
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Sep 13, 2024
Last Updated: Sep 13, 2024

Practice Location

Address: 2995 WARRIOR LN
City: Poplar Bluff
State: Missouri
ZIP Code: 63901-8600
Phone: (573) 712-2902

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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