Healthcare Provider Details

I. General information

NPI: 1538237219
Provider Name (Legal Business Name): REBECCA MARIE PALMER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N BRIDGE ST
SARANAC MI
48881-5102
US

IV. Provider business mailing address

92 N BRIDGE ST
SARANAC MI
48881-5102
US

V. Phone/Fax

Practice location:
  • Phone: 616-642-6466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: