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1053395087

NPI Code Detail

MEDICARE: TERRI FULTON SLP

MEDICARE: TERRI FULTON 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	225400000X	Rehabilitation Practitioner	SL000835 L	PA
2	235Z00000X	Speech-Language Pathologist	SL000835 L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1354279	OTHER	PA	HIGHMARK
2	7721306	OTHER	PA	AETNA HMO
3	819174	OTHER	PA	FIRST PRIORITY/BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2653150	OTHER	PA	AETNA HMO
6	163616	OTHER	PA	MEDPLUS

General Provider Information

NPI Number	:	1053395087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI FULTON SLP

Provider Business Mailing Address
First Line	:	29 N ACADEMY ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2629
Country	:	US
Telephone Number	:	643-311-4008
Fax Number	:	864-331-1416

Provider Business Practice Location Address
First Line	:	29 N ACADEMY ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2629
Country	:	US
Telephone Number	:	643-311-4008
Fax Number	:	864-331-1416

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	06/20/2019

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Directions to “ TERRI FULTON SLP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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