Provider Demographics
NPI:1720232119
Name:PALMER, KIM (MSPCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MSPCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3653
Mailing Address - Country:US
Mailing Address - Phone:518-383-6734
Mailing Address - Fax:
Practice Address - Street 1:10 GINGHAM AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3653
Practice Address - Country:US
Practice Address - Phone:518-383-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist