Provider Demographics
NPI:1811242332
Name:FULTON STEWART, RYAN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:
Last Name:FULTON STEWART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:ELIZABETH
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 BOULDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4165
Mailing Address - Country:US
Mailing Address - Phone:804-385-1197
Mailing Address - Fax:
Practice Address - Street 1:725 JACKSON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5761
Practice Address - Country:US
Practice Address - Phone:540-693-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist