Individual
JORDAN L FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 FIRST EXECUTIVE AVE, SAINT PETERS, MO 63376-2578
(630) 877-0650
Mailing address
600 FIRST EXECUTIVE AVE, SAINT PETERS, MO 63376-2578
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2019026466
MO
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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