Provider Demographics
NPI:1811629744
Name:PALMER, GRACE (HIS)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5945
Mailing Address - Country:US
Mailing Address - Phone:518-438-4340
Mailing Address - Fax:
Practice Address - Street 1:199 WOLF RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5945
Practice Address - Country:US
Practice Address - Phone:518-438-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000065716237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist