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NPI Code Detail

MEDICARE: MR. STEPHEN JOHN PALMER

MEDICARE: MR. STEPHEN JOHN PALMER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor00060MN
2106H00000XMarriage & Family Therapist1751MN

General Provider Information

NPI Number : 1396927869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN JOHN PALMER
Provider Business Mailing Address
First Line : 4140 45TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-3546
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1200 MARQUETTE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55403-2419
Country : US
Telephone Number : 612-432-2163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2007
Last Update Date : 11/27/2007

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Directions to “ MR. STEPHEN JOHN PALMER ” Practice Location

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