Provider Demographics
NPI:1720819030
Name:RUSSOTTO, CLAIRE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:RUSSOTTO
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HARVEST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5972
Mailing Address - Country:US
Mailing Address - Phone:636-851-5100
Mailing Address - Fax:
Practice Address - Street 1:1220 HARVEST RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5972
Practice Address - Country:US
Practice Address - Phone:636-851-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024030426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist