Provider Demographics
NPI:1144062357
Name:PALMER, JOHN RYAN (LMSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RYAN
Last Name:PALMER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 W RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9367
Mailing Address - Country:US
Mailing Address - Phone:208-966-7495
Mailing Address - Fax:
Practice Address - Street 1:1044 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2114
Practice Address - Country:US
Practice Address - Phone:208-930-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-45237104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker