Provider Demographics
NPI:1962029454
Name:PALMER, SHARON SMITH (SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SMITH
Last Name:PALMER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 4125 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8099
Mailing Address - Country:US
Mailing Address - Phone:435-559-1081
Mailing Address - Fax:
Practice Address - Street 1:120 N 4125 W
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8099
Practice Address - Country:US
Practice Address - Phone:435-559-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30153235Z00000X
UT6751021-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist