Individual
SUSAN FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH LANGUAGE PATH
Contact information
Practice address
288 LANCER LANE, MARTINSVILLE, VA 24112
(276) 638-1022
Mailing address
161 HOLLY ST, EDEN, NC 27288-7678
(276) 638-1022
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
220203920
VA
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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