Provider Demographics
NPI:1811190267
Name:PALMER, CAROLE C (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:C
Last Name:PALMER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-9614
Mailing Address - Country:US
Mailing Address - Phone:805-690-6200
Mailing Address - Fax:
Practice Address - Street 1:1150 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:SANTA YNEZ
Practice Address - State:CA
Practice Address - Zip Code:93460-9614
Practice Address - Country:US
Practice Address - Phone:805-690-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist