Provider Demographics
NPI:1215241997
Name:CRUZ-FULLER, CLAUDIA (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:
Last Name:CRUZ-FULLER
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:MS
Other - First Name:CLAUDIA
Other - Middle Name:M
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:4820 HIGHWAY 90 # 32
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6372
Mailing Address - Country:US
Mailing Address - Phone:719-645-9390
Mailing Address - Fax:
Practice Address - Street 1:4820 HIGHWAY 90 # 32
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6372
Practice Address - Country:US
Practice Address - Phone:719-645-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty