Provider Demographics
NPI:1316710858
Name:FULCHER, GRACE ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ANNE
Last Name:FULCHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3735
Mailing Address - Country:US
Mailing Address - Phone:210-837-4257
Mailing Address - Fax:
Practice Address - Street 1:8100 LOMO ALTO DR STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6575
Practice Address - Country:US
Practice Address - Phone:214-351-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist