Most Relevant Information
Provider Data
| NPI Number: | 1003655945 |
| Provider Name: | SAMUEL FULLER |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/21/2024 |
| Last Updated: | 05/21/2024 |
Provider Practice Location
59 GLENN RD NW
ALEXANDRIA
MN
563084007
Practice Location Phone/Fax
| Phone: | 3202197644 |
| Fax: |
Provider Mailing Location
59 GLENN RD NW
ALEXANDRIA
MN
563084007
Provider Mailing Phone/Fax
| Phone: | 3202197644 |
| Fax: |