Individual
ELIZABETH FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 276-3900
Mailing address
4109 HWY 98 W, SUMMIT, MS 39666
(601) 276-3900
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4089
AL
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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