Jennifer Leigh Russell (NPI# 1114347846, PAC ID# 1951626035) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PSYCHOLOGIST, CLINICAL.
| Nation Provider ID (NPI) | 1114347846 |
| PAC ID by PECOS | 1951626035 |
| Professional Enrollment ID | I20170728000500 |
| Full Name | Jennifer Leigh Russell |
| Organization Legal Name | RONALD A GOEBEL AND MARK P VIGEN PTR |
| Address |
3218 Line Ave Suite 111 Shreveport LA 71104-4261 |
| Phone Number | 3184252000 |
| Gender | F |
| Graduation Year | 2009 |
| Primary Specialty | PSYCHOLOGIST, CLINICAL |
| Group Practice PAC ID | 2163582925 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 | 3184252000 | RONALD A GOEBEL AND MARK P VIGEN PTR |
| Organization Legal Name | RONALD A GOEBEL AND MARK P VIGEN PTR |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shelley Visconte | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Mark P Vigen | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Michael Todd Lobrano | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Ronald A Goebel | Clinical Psychologist | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Shreveport, LA 71104-4261 |
| Street Address |
3218 LINE AVE SUITE 111 |
| City | SHREVEPORT |
| State | LA |
| Zip | 71104-4261 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shelley Visconte | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Mark P Vigen | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Michael Todd Lobrano | Psychologist, Clinical | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Suite 111, Shreveport, LA 71104-4261 |
| Ronald A Goebel | Clinical Psychologist | Ronald A Goebel and Mark P Vigen Ptr | 3218 Line Ave, Shreveport, LA 71104-4261 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Rita M Marascalco King | Nurse Practitioner | Lsu Health Sciences Center-shreveport Faculty Group Practice | 2015 Fairfield Ave 2b Ptrs In Wellness, Lsu Hlth Sci Ctr Shreveport, Shreveport, LA 71104-2066 |
| Charles E Lyon | Ophthalmology | Charles E Lyon, Md, Apmc | 836 Olive St, Shreveport, LA 71104-2102 |
| Travis Jones | Optometry | Charles E Lyon, Md, Apmc | 836 Olive St, Shreveport, LA 71104-2102 |
| George R Merriman | General Surgery | 949 Olive St, Shreveport, LA 71104-2103 | |
| Laurence E Welker | Podiatry | 915 Olive St, Shreveport, LA 71104-2103 | |
| Thomas M Nosser | Chiropractic | 915 Olive St, Shreveport, LA 71104-2103 | |
| William Watkins | Otolaryngology | Ear Nose and Throat Center A Medical Corporation | 2121 Line Ave, Shreveport, LA 71104-2126 |
| Blakely Nelson Thornton | Otolaryngology | Ear Nose and Throat Center A Medical Corporation | 2121 Line Ave, Shreveport, LA 71104-2126 |
| Laura Wade | Qualified Audiologist | Ear Nose and Throat Center A Medical Corporation | 2121 Line Ave, Shreveport, LA 71104-2126 |
| Courtney Leigh Ross | Qualified Audiologist | Ear Nose and Throat Center A Medical Corporation | 2121 Line Ave, Shreveport, LA 71104-2126 |
| Find all physicians in zip 71104 | |||
| City | SHREVEPORT |
| Zip Code | 71104 |
| Specialty | PSYCHOLOGIST, CLINICAL |
| City + Specialty | SHREVEPORT + PSYCHOLOGIST, CLINICAL |
Please comment or provide details below to improve the information on Jennifer Leigh Russell.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.