Mason Daniel Russo

NPI #1760269815 in Jenison, Michigan

Provider Information

NPI Number: 1760269815
Entity Type: Individual
Name: Mason Daniel Russo
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Sep 12, 2023
Last Updated: Sep 12, 2023

Practice Location

Address: 8413 COTTONWOOD DR
City: Jenison
State: Michigan
ZIP Code: 49428-8327
Phone: (574) 387-4313

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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