Provider Demographics
NPI:1023343522
Name:PALMER, KAREN SUE (MS, LCPC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 ENGLISH PINE LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2577
Mailing Address - Country:US
Mailing Address - Phone:618-589-9599
Mailing Address - Fax:
Practice Address - Street 1:6 EMERALD TER STE 4
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2312
Practice Address - Country:US
Practice Address - Phone:618-233-0500
Practice Address - Fax:618-233-7935
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.001475OtherPROFESSIONAL LICENSE NO.