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General NPI Number Information
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NPI Number | 1831552512
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Entity Type | Individual
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Provider Name | ANNE FULTON SLP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 10 EVERETT CT
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City | BLOOMINGTON
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State | IL
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Zip | 61705-6557
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Country | US
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Telephone | 309-622-1502
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E COLLEGE AVE STE A168
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City | NORMAL
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State | IL
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Zip | 61761-4507
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Country | US
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Telephone | 309-622-1502
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Fax |
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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 | 146.004685
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License Number State | IL
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