Provider Demographics
NPI:1437423753
Name:PALMER, LORI ALYSE (LBSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ALYSE
Last Name:PALMER
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N MIDDLE ST
Mailing Address - Street 2:APT 6
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5612
Mailing Address - Country:US
Mailing Address - Phone:573-275-2448
Mailing Address - Fax:
Practice Address - Street 1:224 N FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5626
Practice Address - Country:US
Practice Address - Phone:573-332-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02744104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02744OtherSOCIAL WORK LICENSE NUMBER