| Doctor Name: | DENNIS PAUL FULLER |
| NPI Number: | 1982665675 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD CCC SLP |
| License Number: | 00071 |
| Business Practice Address: | 3660 Vista St Louis, MO - 63110 |
| Business Phone Number: | 3149775110 |
| Business Fax Number: | 3142685111 |
| Mailing Address: | 3691 Rutger Ave, Provider Enrollment ST LOUIS |
| State: | MO |
| Postal Code: | 63110 |
| Phone Number: | 3149774440 |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2006 |
| NPI Last Update Date: | 01/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 00071 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| 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 |