Provider Demographics
NPI:1356563191
Name:PALMA, ANNE SHARON (MA,MS,LPCC, SLP-CCC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:SHARON
Last Name:PALMA
Suffix:
Gender:F
Credentials:MA,MS,LPCC, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CEBOLLA LOOP
Mailing Address - Street 2:
Mailing Address - City:JEMEZ SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:87025-9241
Mailing Address - Country:US
Mailing Address - Phone:505-249-5046
Mailing Address - Fax:
Practice Address - Street 1:4216 BALLOON PARK RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5801
Practice Address - Country:US
Practice Address - Phone:505-344-5470
Practice Address - Fax:505-344-9343
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0814101YM0800X
NM245371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00321752OtherSLP-CCC, ASHA
NM0814OtherLPCC
NM94139512Medicaid