Provider Demographics
NPI:1134340193
Name:FULLERTON, JAMA L (SLP)
Entity type:Individual
Prefix:
First Name:JAMA
Middle Name:L
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RIVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4532
Mailing Address - Country:US
Mailing Address - Phone:501-305-3635
Mailing Address - Fax:
Practice Address - Street 1:105 RIVER OAKS CT
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4532
Practice Address - Country:US
Practice Address - Phone:501-305-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist