Individual
LORENZA FULLMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
Mailing address
1212 W 100 S, BLACKFOOT, ID 83221-6035
(208) 221-0080
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP 2380
ID
Other
Enumeration date
07/23/2014
Last updated
09/03/2014
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