Andrea Russell
Community/Behavioral Health in Rigby, ID. Organization (NPI-2).
NPI number1104769520
StatusActive
Last updated in NPPESMay 13, 2026
Details
- NPI
- 1104769520
- Entity type
- Organization (NPI-2)
- Legal business name
- Andrea Russell
- Organization subpart
- No
- Enumeration date
- Apr 10, 2026
- Certification date
- May 13, 2026
- Last updated
- May 13, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
| 222Q00000X | Developmental Therapist | – | – |
Practice location
1200 Jaylee Dr Unit 1Rigby, ID 83442-5273
Phone 208-419-9383
Mailing address
1200 Jaylee Dr Unit 1Rigby, ID 83442-5273
Phone 208-419-9383
Authorized official
Andrea Russell
Intervention Professional
2084199383
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