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Individual

ELLEN FULK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SLP

Contact information

Practice address
14020 OLD STATE RD STE D100, EVANSVILLE, IN 47725-1164
(812) 469-4770
Mailing address
5927 RELIABLE PWY, CHICAGO, IL 60686-0001

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006633A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PENDING
PENDING
Enumeration date
11/01/2016
Last updated
04/06/2021
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