Doctor Name: | HEATHER D FULLERTON |
NPI Number: | 1033264189 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CFY-SLP |
License Number: | C3784 |
Business Practice Address: | 810 E 21st St Ste 6 Clovis, NM - 881014442 |
Business Phone Number: | 5059356322 |
Business Fax Number: | |
Mailing Address: | 913 Laurelwood Dr, CLOVIS |
State: | NM |
Postal Code: | 881013052 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | C3784 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |