Doctor Name: | JASON FULLER |
NPI Number: | 1972718401 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. CCC-SLP |
License Number: | 1372 |
Business Practice Address: | 1208 W Pleasure Ave Searcy, AR - 721435151 |
Business Phone Number: | 5012303916 |
Business Fax Number: | |
Mailing Address: | 708 W Academy Ave, SEARCY |
State: | AR |
Postal Code: | 721434109 |
Phone Number: | 5012303916 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2007 |
NPI Last Update Date: | 07/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1372 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
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 |