Provider Demographics
NPI:1013294453
Name:FULCHER, KATRINA (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:
Last Name:FULCHER
Suffix:
Gender:F
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 1:155 CHANDLER STREET
Mailing Address - Street 2:SUITE 6, OFFICE 129
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207
Mailing Address - Country:US
Mailing Address - Phone:716-541-0448
Mailing Address - Fax:
Practice Address - Street 1:155 CHANDLER STREET
Practice Address - Street 2:SUITE 6, OFFICE 129
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207
Practice Address - Country:US
Practice Address - Phone:716-541-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021091-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist