Provider Demographics
NPI:1386951283
Name:FULLAGAR, ANN E
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:FULLAGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOLLY MAUK ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1566
Mailing Address - Country:US
Mailing Address - Phone:207-865-4561
Mailing Address - Fax:
Practice Address - Street 1:20 MOLLY MAUK ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1566
Practice Address - Country:US
Practice Address - Phone:207-865-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist