Healthcare Provider Details

I. General information

NPI: 1699420455
Provider Name (Legal Business Name): ALEXANDRA PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N MAIN ST
FINDLAY OH
45840-3972
US

IV. Provider business mailing address

530 S MAIN ST
LIMA OH
45804-1500
US

V. Phone/Fax

Practice location:
  • Phone: 567-371-4418
  • Fax:
Mailing address:
  • Phone: 567-371-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number34-1475943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: