Individual
AMY MARIE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 THERESA AVE, AMERICAN CANYON, CA 94503-9654
(707) 561-0922
Mailing address
2409 VAN PATTER DR, SANTA ROSA, CA 95403-7695
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-19551
CA
Other
Enumeration date
08/08/2017
Last updated
08/08/2017
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