MEDICARE: MRS. KACI CORRINE FULMER M.S., SLP-INTERN

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		TX

General Provider Information

NPI Number	:	1184347361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KACI CORRINE FULMER M.S., SLP-INTERN

Provider Business Mailing Address
First Line	:	10300 JONES RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-4208
Country	:	US
Telephone Number	:	281-897-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	16823 WEST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5503
Country	:	US
Telephone Number	:	281-856-5100
Fax Number	:

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

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	09/22/2022

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Directions to “ MRS. KACI CORRINE FULMER M.S., SLP-INTERN” Practice Location

Language	Start Address	Practice Location

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