Individual
MRS. ELIZABETH ANN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
636 N EDGEWOOD AVE, LOMBARD, IL 60148
(630) 916-0054
Mailing address
636 N EDGEWOOD AVE, LOMBARD, IL 60148-1940
(630) 916-0054
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146 007564
IL
Other
Enumeration date
08/03/2006
Last updated
06/26/2008
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