Healthcare Provider Details

I. General information

NPI: 1356563191
Provider Name (Legal Business Name): ANNE SHARON PALMA MA,MS,LPCC, SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 BALLOON PARK RD NE
ALBUQUERQUE NM
87109-5801
US

IV. Provider business mailing address

3 CEBOLLA LOOP
JEMEZ SPRINGS NM
87025-9241
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-5470
  • Fax: 505-344-9343
Mailing address:
  • Phone: 505-249-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0814
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number245371
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: