=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568254019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAE PALMER VOICE AND SPEECH SERVICES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2025
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 F ST
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91910-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-289-7158
-----------------------------------------------------
Fax | 541-230-2691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 F ST
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91910-2802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-289-7158
-----------------------------------------------------
Fax | 541-230-2691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RAE PALMER
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 619-289-7158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------