Individual
MS. THERESA K FULLHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
905 MONTGOMERY STREET, DECORAH, IA 52101
(563) 382-3649
(563) 382-8183
Mailing address
905 MONTGOMERY ST, DECORAH, IA 52101-2325
(563) 382-3649
(563) 382-8183
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
05866
IA
Other
Enumeration date
05/10/2006
Last updated
08/18/2010
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