Organization
HAISLUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH A FULLER (SPEECH PATHOLOGIST)
(314) 892-8862
Entity
Organization
Contact information
Practice address
100 S GARRISON AVE, SAINT LOUIS, MO 63103-2538
(314) 340-5902
Mailing address
5511 STARLIT DR, SAINT LOUIS, MO 63129-2245
(314) 892-8862
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LIFESTATE
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
466692811
—
MO
Enumeration date
06/18/2007
Last updated
06/16/2008
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