Provider Demographics
NPI:1841033818
Name:PALOMO, ISAAC (CRM)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:PALOMO
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:SILETZ
Mailing Address - State:OR
Mailing Address - Zip Code:97380-0320
Mailing Address - Country:US
Mailing Address - Phone:541-444-1030
Mailing Address - Fax:503-390-8099
Practice Address - Street 1:3160 BLOSSOM DR NE STE 105
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-3954
Practice Address - Country:US
Practice Address - Phone:503-390-9494
Practice Address - Fax:503-390-8099
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-33481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical