Provider Demographics
NPI:1205917267
Name:PALMER, KIMBERLY DAWN (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:PALMER
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:24 N SAINT JOSEPH AVE
Mailing Address - Street 2:C 1
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2263
Mailing Address - Country:US
Mailing Address - Phone:269-683-0800
Mailing Address - Fax:269-683-7638
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-273
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-0180
Practice Address - Fax:269-381-7347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI35-01-003406237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2996538Medicaid
MI010689294050Medicaid
MI4439159Medicaid
MI640A126090Medicare UPIN
MI010689294050Medicaid
MI540A103560Medicare UPIN
MI0C97625Medicare PIN