Provider Demographics
NPI:1942014238
Name:KITTREDGE, RUSSA INGRIS
Entity type:Individual
Prefix:
First Name:RUSSA
Middle Name:INGRIS
Last Name:KITTREDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 SW MADISON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4924
Mailing Address - Country:US
Mailing Address - Phone:541-712-8652
Mailing Address - Fax:
Practice Address - Street 1:257 SW MADISON AVE STE 230
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4924
Practice Address - Country:US
Practice Address - Phone:541-712-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health