MEDICARE: SUZANNE HEPLER FULLER

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	003807	GA

General Provider Information

NPI Number	:	1942754023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE HEPLER FULLER

Provider Business Mailing Address
First Line	:	15 HOLLY CIR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9647
Country	:	US
Telephone Number	:	706-414-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 HOLLY CIR
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-9647
Country	:	US
Telephone Number	:	706-414-6773
Fax Number	:

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

Provider Enumeration Date	:	08/07/2016
Last Update Date	:	08/07/2016

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Directions to “ SUZANNE HEPLER FULLER ” Practice Location

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