MEDICARE: VANESSA E. PALMER ACLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	BBH-ACLC-LIC-72399	MT

General Provider Information

NPI Number	:	1578376497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA E. PALMER ACLC

Provider Business Mailing Address
First Line	:	1079A NORTH MERIDIAN RD. #208
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901
Country	:	US
Telephone Number	:	406-396-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	9549 US ROUTE 2
Second Line	:
City	:	MARTIN CITY
State	:	MT
Zip	:	59926
Country	:	US
Telephone Number	:	406-607-5600
Fax Number	:

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

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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