Individual
STACY ELIZABETH FULMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2740 COLLEGE AVE, CONWAY, AR 72034-6141
(501) 329-5459
Mailing address
4435 TREE HOUSE DR, CONWAY, AR 72034-8265
(501) 336-9956
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1066
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134277320
—
AR
Enumeration date
08/25/2008
Last updated
08/25/2008
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