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General NPI Number Information
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NPI Number | 1003230475
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Entity Type | Individual
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Provider Name | LAUREN ASHLEY FULLEN M.S. CCC-SLP, MBA
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Gender | Female
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 103 NORTH ST
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City | BRISTOL
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State | VA
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Zip | 24201-3201
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Country | US
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Telephone | 276-642-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 103 NORTH ST
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City | BRISTOL
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State | VA
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Zip | 24201-3201
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Country | US
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Telephone | 276-642-7900
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Fax | 276-642-8091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4084
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202006003
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License Number State | VA
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