Individual
JARED AUSTIN FULGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
6410 OLD MAIN HL, LOGAN, UT 84322-6410
(435) 797-1375
(844) 308-5865
Mailing address
6410 OLD MAIN HL, LOGAN, UT 84322-6410
(435) 797-1375
(844) 308-5865
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9451387-4102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9451387-4102
STATE LICENSE
UT
01
—
SLP-3236
STATE LICENSE
ID
Enumeration date
06/25/2019
Last updated
06/25/2019
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