Provider Demographics
NPI:1679052591
Name:DROLL, RUSSELL PATRICK
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:PATRICK
Last Name:DROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NW GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2943
Mailing Address - Country:US
Mailing Address - Phone:541-205-9159
Mailing Address - Fax:458-202-4681
Practice Address - Street 1:45 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2943
Practice Address - Country:US
Practice Address - Phone:541-205-9159
Practice Address - Fax:458-202-4681
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health