Provider Demographics
NPI:1750823712
Name:PALOMBO, PAULETTE
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:
Last Name:PALOMBO
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 1:2200 S US HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9470
Mailing Address - Country:US
Mailing Address - Phone:937-484-1557
Mailing Address - Fax:937-484-1571
Practice Address - Street 1:899 NORWOOD DR
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1041
Practice Address - Country:US
Practice Address - Phone:614-879-7642
Practice Address - Fax:614-879-5377
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.1890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist