Provider Demographics
NPI:1386653582
Name:PALMER, CAROL ANN (MS,SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BAUER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952-2424
Mailing Address - Country:US
Mailing Address - Phone:618-833-8682
Mailing Address - Fax:618-833-5683
Practice Address - Street 1:85 BAUER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IL
Practice Address - Zip Code:62952-2424
Practice Address - Country:US
Practice Address - Phone:618-833-8682
Practice Address - Fax:618-833-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist