Individual
MRS. RITA GRACE FORTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSP
Contact information
Practice address
ROUTE 10, WYOMING COUNTY BOARD OF EDUCATION, PINEVILLE, WV 24874
(304) 732-6262
(304) 732-8569
Mailing address
HC63 BOX 936, PANTHER, WV 24872
(304) 938-3053
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
ASHA12048761
WV
235Z00000X
Speech-Language Pathologist
WVSLP0921
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9409126000
—
WV
Enumeration date
09/07/2007
Last updated
09/07/2007
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