Provider Demographics
NPI:1790958858
Name:FULFORD, TERAN RENEE (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:TERAN
Middle Name:RENEE
Last Name:FULFORD
Suffix:
Gender:M
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 TARA DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7526
Mailing Address - Country:US
Mailing Address - Phone:334-491-0148
Mailing Address - Fax:
Practice Address - Street 1:298 JAY ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6062
Practice Address - Country:US
Practice Address - Phone:334-361-6008
Practice Address - Fax:334-491-0500
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist