1356563191 NPI number — ANNE SHARON PALMA MA,MS,LPCC, SLP-CCC

Table of content: ANNE SHARON PALMA MA,MS,LPCC, SLP-CCC (NPI 1356563191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356563191 NPI number — ANNE SHARON PALMA MA,MS,LPCC, SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMA
Provider First Name:
ANNE
Provider Middle Name:
SHARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,MS,LPCC, SLP-CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356563191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 CEBOLLA LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEMEZ SPRINGS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87025-9241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-249-5046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4216 BALLOON PARK RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-344-5470
Provider Business Practice Location Address Fax Number:
505-344-9343
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0814 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 245371 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00321752 . This is a "SLP-CCC, ASHA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0814 . This is a "LPCC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 94139512 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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