Healthcare Provider Details

I. General information

NPI: 1558259317
Provider Name (Legal Business Name): WENDY PALMA AUSTIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 SKYPARK DR STE 102
MEDFORD OR
97504-5395
US

IV. Provider business mailing address

1998 SKYPARK DR STE 102
MEDFORD OR
97504-5395
US

V. Phone/Fax

Practice location:
  • Phone: 541-500-1022
  • Fax:
Mailing address:
  • Phone: 541-500-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberR9714
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9714
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: