| Doctor Name: | MS. JOAN N FULLER |
| NPI Number: | 1023440377 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | |
| Business Practice Address: | 901 4th St Suite 160 Hudson, WI - 540161681 |
| Business Phone Number: | 7632109966 |
| Business Fax Number: | 7632106886 |
| Mailing Address: | 1497 Mallard Ave, BALDWIN |
| State: | WI |
| Postal Code: | 540025561 |
| Phone Number: | 6513299112 |
| Fax Number: | |
| NPI Enumeration Date: | 08/08/2013 |
| NPI Last Update Date: | 10/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |