Provider Demographics
NPI:1285753483
Name:RUSSELL CHILD DEVELOPMENT
Entity type:Organization
Organization Name:RUSSELL CHILD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DEVELOPMENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCIE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:CROTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-275-0291
Mailing Address - Street 1:714 BALLINGER ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5918
Mailing Address - Country:US
Mailing Address - Phone:620-275-0291
Mailing Address - Fax:620-275-0364
Practice Address - Street 1:714 BALLINGER ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5918
Practice Address - Country:US
Practice Address - Phone:620-275-0291
Practice Address - Fax:620-275-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty