Provider Demographics
NPI:1750689154
Name:PALMER, MARILYN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7180 SW FIR LOOP
Mailing Address - Street 2:1A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8023
Mailing Address - Country:US
Mailing Address - Phone:503-639-3009
Mailing Address - Fax:503-620-3453
Practice Address - Street 1:7180 SW FIR LOOP
Practice Address - Street 2:1A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8023
Practice Address - Country:US
Practice Address - Phone:503-639-3009
Practice Address - Fax:503-620-3453
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health