MEDICARE: MS. REBECCA ANN FULLER M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		WI

General Provider Information

NPI Number	:	1881945392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA ANN FULLER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2815 COUNTY HIGHWAY I
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-2656
Country	:	US
Telephone Number	:	715-723-9341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 COUNTY HIGHWAY I
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-2656
Country	:	US
Telephone Number	:	715-723-9341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	11/12/2019

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Directions to “ MS. REBECCA ANN FULLER M.S. CCC-SLP” Practice Location

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