MEDICARE: MRS. EMILY LOU PALMER M.S. CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP-2080	ID

General Provider Information

NPI Number	:	1487947628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY LOU PALMER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	3331 E LARSON DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-5053
Country	:	US
Telephone Number	:	208-313-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 S UTAH AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-3322
Country	:	US
Telephone Number	:	208-535-1286
Fax Number	:	208-535-1291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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