MEDICARE: MR. DEREK PALMER MA, CCC-SLP, BCS-S

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	146.010439	IL

General Provider Information

NPI Number	:	1538417282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEREK PALMER MA, CCC-SLP, BCS-S

Provider Business Mailing Address
First Line	:	5758 S MARYLAND AVE
Second Line	:	DCAM 4517, MC9020
City	:	CHICAGO
State	:	IL
Zip	:	60637-1426
Country	:	US
Telephone Number	:	773-702-4004
Fax Number	:

Provider Business Practice Location Address
First Line	:	5758 S MARYLAND AVE
Second Line	:	DCAM 4517, MC9020
City	:	CHICAGO
State	:	IL
Zip	:	60637-1426
Country	:	US
Telephone Number	:	773-702-4004
Fax Number	:

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

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	11/27/2016

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Directions to “ MR. DEREK PALMER MA, CCC-SLP, BCS-S” Practice Location

Language	Start Address	Practice Location

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