Individual
DENNIS PAUL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD CCC SLP
Contact information
Practice address
3660 VISTA, ST LOUIS, MO 63110
(314) 977-5110
(314) 268-5111
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
00071
MO
Other
Enumeration date
03/31/2006
Last updated
01/09/2008
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