Provider Demographics
NPI:1710372545
Name:PALMER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PALMER
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:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:RATTAN
Mailing Address - State:OK
Mailing Address - Zip Code:74562-0141
Mailing Address - Country:US
Mailing Address - Phone:580-372-1686
Mailing Address - Fax:
Practice Address - Street 1:604 7TH ST
Practice Address - Street 2:
Practice Address - City:BOSWELL
Practice Address - State:OK
Practice Address - Zip Code:74727
Practice Address - Country:US
Practice Address - Phone:580-372-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist