Individual
TAYTUM FAY FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC SLP
Contact information
Practice address
123 W CASCADE WAY, SPOKANE, WA 99208-6017
(509) 624-3115
(509) 624-4374
Mailing address
2347 S SOUTHEAST BLVD APT 4, SPOKANE, WA 99203-4535
(509) 793-6564
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
61160992
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL61304692
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
06/01/2021
Last updated
06/15/2022
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