Provider Demographics
NPI:1093146086
Name:FULLER, LAURA LINDA (CCC/SLP, MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LINDA
Last Name:FULLER
Suffix:
Gender:F
Credentials:CCC/SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 CHAMA TRCE
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5311
Mailing Address - Country:US
Mailing Address - Phone:512-497-4885
Mailing Address - Fax:
Practice Address - Street 1:485 CHAMA TRCE
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5311
Practice Address - Country:US
Practice Address - Phone:512-497-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist