Provider Demographics
NPI:1750505079
Name:PALMER, NECOLE C (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:C
Last Name:PALMER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:NECOLE
Other - Middle Name:C
Other - Last Name:KOESTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5803 ISLIP DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-474-7802
Mailing Address - Fax:573-815-2605
Practice Address - Street 1:1601 E BROADWAY # 33
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8020
Practice Address - Country:US
Practice Address - Phone:573-815-3868
Practice Address - Fax:573-815-2605
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003011034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist