Provider Demographics
NPI:1457581886
Name:PALACIOS, EDIEBERTO (AUD)
Entity Type:Individual
Prefix:DR
First Name:EDIEBERTO
Middle Name:
Last Name:PALACIOS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 CLIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2209
Mailing Address - Country:US
Mailing Address - Phone:717-977-1604
Mailing Address - Fax:
Practice Address - Street 1:2702 CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2209
Practice Address - Country:US
Practice Address - Phone:717-977-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80240231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist