Provider Demographics
NPI:1629452354
Name:FULTON, SARA ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:FULTON
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:2400 WINCHESTER PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1518
Mailing Address - Country:US
Mailing Address - Phone:864-576-7188
Mailing Address - Fax:864-576-8909
Practice Address - Street 1:2400 WINCHESTER PL
Practice Address - Street 2:SUITE 102
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1518
Practice Address - Country:US
Practice Address - Phone:864-576-7188
Practice Address - Fax:864-576-8909
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC5569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist