Provider Demographics
NPI:1821166612
Name:FULTON, JOANNE RUTH (MSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:RUTH
Last Name:FULTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 FORUM BLVD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6322
Mailing Address - Country:US
Mailing Address - Phone:573-446-6290
Mailing Address - Fax:573-446-0618
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:SUITE 3A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6322
Practice Address - Country:US
Practice Address - Phone:573-446-6290
Practice Address - Fax:573-446-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical