Individual
ANDREW MACKENZIE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CF-SLP
Contact information
Practice address
10401 W CHARLESTON BLVD, LAS VEGAS, NV 89135-1151
(702) 207-4242
Mailing address
935 KESWICK BLVD, LOUISVILLE, KY 40217-2136
(502) 341-9369
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202011795
VA
235Z00000X
Speech-Language Pathologist
Primary
SP-3013
NV
Other
Enumeration date
06/16/2021
Last updated
04/20/2026
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