Individual
MRS. LISA MARIE FULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
8640 EAGLE CREEK CIR, SAVAGE, MN 55378-4400
(952) 746-7664
(952) 224-4867
Mailing address
8640 EAGLE CREEK CIR, SAVAGE, MN 55378-4400
(952) 746-7664
(952) 224-4867
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24549
MN
Other
Enumeration date
02/08/2016
Last updated
08/11/2016
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