Provider Demographics
NPI:1225312481
Name:PALMER, CARRIE KRISTIN (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:KRISTIN
Last Name:PALMER
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 STATE HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-3747
Mailing Address - Country:US
Mailing Address - Phone:518-736-4305
Mailing Address - Fax:
Practice Address - Street 1:2755 STATE HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-3747
Practice Address - Country:US
Practice Address - Phone:518-736-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009582-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist