Individual
LAURA LYN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3012 N 17TH AVE, PHOENIX, AZ 85015-6112
(480) 824-8889
Mailing address
3012 N 17TH AVE, PHOENIX, AZ 85015-6112
(480) 824-8889
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP8363
AZ
Other
Enumeration date
07/23/2013
Last updated
08/13/2019
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