Jaizane Alexis Russell
Social Worker, Clinical in Dayton, OH. Individual provider (NPI-1).
NPI number1982189247
StatusActive
Last updated in NPPESJan 3, 2025
Details
- NPI
- 1982189247
- Entity type
- Individual (NPI-1)
- Name
- Ms. Jaizane Alexis Russell
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 2, 2018
- Certification date
- Jan 3, 2025
- Last updated
- Jan 3, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | I-2405497 | OH | Yes |
| 104100000X | Social Worker | S.1903283 | OH |
Practice location
1 Elizabeth PlDayton, OH 45417-3445
Phone 937-234-0121
Mailing address
5244 W 2nd StDayton, OH 45417-9044
Phone 937-818-9506
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