Provider Demographics
NPI:1770526295
Name:FULLER, MARGARET ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:FULLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARGARET
Other - Middle Name:F
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:270 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2052
Mailing Address - Country:US
Mailing Address - Phone:724-349-5070
Mailing Address - Fax:724-349-8368
Practice Address - Street 1:270 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2052
Practice Address - Country:US
Practice Address - Phone:724-349-5070
Practice Address - Fax:724-349-8368
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002538L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018893190004Medicaid
PA992993OtherBCBS