Provider Demographics
NPI:1114346103
Name:PALMER, KIMBERLY SUE (MS CCC/SLP CALT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS CCC/SLP CALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 BATON ROUGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5102
Mailing Address - Country:US
Mailing Address - Phone:972-672-9119
Mailing Address - Fax:
Practice Address - Street 1:4350 SIGMA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4421
Practice Address - Country:US
Practice Address - Phone:469-385-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist