Provider Demographics
NPI:1063109734
Name:ASONE SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:ASONE SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:309-204-4961
Mailing Address - Street 1:1900 E COLLEGE AVE STE A168
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4507
Mailing Address - Country:US
Mailing Address - Phone:309-204-4961
Mailing Address - Fax:
Practice Address - Street 1:10 EVERETT CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-6557
Practice Address - Country:US
Practice Address - Phone:309-204-4961
Practice Address - Fax:844-777-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech