Provider Demographics
NPI:1295863991
Name:FULLER, DONALD R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:FULLER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N. RIVERPOINT BLVD.
Mailing Address - Street 2:BOX V
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1675
Mailing Address - Country:US
Mailing Address - Phone:509-358-7581
Mailing Address - Fax:509-368-6890
Practice Address - Street 1:310 N. RIVERPOINT BLVD.
Practice Address - Street 2:BOX V
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1675
Practice Address - Country:US
Practice Address - Phone:509-358-7581
Practice Address - Fax:509-368-6890
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist