Provider Demographics
NPI:1407065097
Name:PALMER, ELIZABETH LOUISE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:PALMER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 TENNYSON AVE NE APT 9
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2694
Mailing Address - Country:US
Mailing Address - Phone:330-221-8200
Mailing Address - Fax:
Practice Address - Street 1:2112 TENNYSON AVE NE APT 9
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2694
Practice Address - Country:US
Practice Address - Phone:330-221-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist