Individual
JASON FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S. CCC-SLP
Contact information
Practice address
1208 W PLEASURE AVE, SEARCY, AR 72143-5151
(501) 230-3916
Mailing address
708 W ACADEMY AVE, SEARCY, AR 72143-4109
(501) 230-3916
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1372
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135025721
—
AR
01
—
5T864
AR BLUECROSS BLUESHIELD
AR
Enumeration date
05/10/2007
Last updated
07/26/2011
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