Individual
BRACI LEANNELL FULKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS-CCC-SLP
Contact information
Practice address
800 S DIVISION ST, NORRIS CITY, IL 62869-1634
(618) 378-2131
Mailing address
800 S DIVISION ST, NORRIS CITY, IL 62869-1634
(618) 841-9044
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146010823
IL
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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