Healthcare Provider Details

I. General information

NPI: 1437819406
Provider Name (Legal Business Name): KODIE PALMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S WADSWORTH BLVD UNIT 2
LAKEWOOD CO
80226-4300
US

IV. Provider business mailing address

777 S WADSWORTH BLVD UNIT 2
LAKEWOOD CO
80226-4300
US

V. Phone/Fax

Practice location:
  • Phone: 720-485-3756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: