Ellen-Beth Fullwood, MS CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA9064 Issued in FL

Practice address

15114 Cloverdale Dr
Fort Myers, FL 33919-8308

Phone

(239) 410-2629

Fax

(309) 410-2629

NPI assigned

Sep 24, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  Speech-Language Pathologist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222214400000",
    "number": "1386894574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15114 CLOVERDALE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339198308",
            "telephone_number": "239-410-2629",
            "fax_number": "309-410-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15114 CLOVERDALE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339198308",
            "telephone_number": "239-410-2629",
            "fax_number": "309-410-2629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLWOOD",
        "first_name": "ELLEN-BETH",
        "name_prefix": "Ms.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-24",
        "last_updated": "2008-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA9064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billy Ray Fulk, M.D.
• Chante Fuller
• James H Fuller, MD
• Rasheka Fuller
• Chelsea Cree Fullgrapp, DDS
• Fulton Chiropractic P a
• Charles L Fulton, D.C.
• Alexandra Fumero
• Functional Rehab of East Ft. Myers, Inc.
• Breana Nicole Fundermark

• Speech-Language Pathologist in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.