Provider Demographics
NPI:1053395087
Name:FULTON, TERRI (SLP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 N ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2629
Mailing Address - Country:US
Mailing Address - Phone:643-311-4008
Mailing Address - Fax:864-331-1416
Practice Address - Street 1:29 N ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:643-311-4008
Practice Address - Fax:864-331-1416
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000835 L225400000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1354279OtherHIGHMARK
PA7721306OtherAETNA HMO
PA819174OtherFIRST PRIORITY/BC/BS
PA001862010004Medicaid
PA2653150OtherAETNA HMO
PA163616OtherMEDPLUS