Dezirae Louise Russo

NPI #1235697046 in Kentwood, Michigan

Provider Information

NPI Number: 1235697046
Entity Type: Individual
Name: Dezirae Louise Russo
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Mar 11, 2019
Last Updated: Mar 11, 2019

Practice Location

Address: 3361 36TH ST SE
City: Kentwood
State: Michigan
ZIP Code: 49512-2809
Phone: (616) 942-2522

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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