MEDICARE: DANA FULCHER

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	41YS010443000	NJ

General Provider Information

NPI Number	:	1104406719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA FULCHER

Provider Business Mailing Address
First Line	:	1123 MEADOWS DR
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-3134
Country	:	US
Telephone Number	:	609-670-7883
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 EVES DR
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3129
Country	:	US
Telephone Number	:	609-670-7883
Fax Number	:

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

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	10/28/2021

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Directions to “ DANA FULCHER ” Practice Location

Language	Start Address	Practice Location

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