Provider Demographics
NPI:1467089714
Name:PALMER-OLDS, CECELIA J
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:J
Last Name:PALMER-OLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19805 COAL HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2954
Mailing Address - Country:US
Mailing Address - Phone:304-436-2106
Mailing Address - Fax:
Practice Address - Street 1:19805 COAL HERITAGE RD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2954
Practice Address - Country:US
Practice Address - Phone:304-436-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005489001Medicaid