MEDICARE: DR. MARILYN ELIZABETH PALMER PH.D.

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	101YM0800X	Mental Health Counselor	CO223	OR

General Provider Information

NPI Number	:	1750689154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN ELIZABETH PALMER PH.D.

Provider Business Mailing Address
First Line	:	7180 SW FIR LOOP
Second Line	:	1A
City	:	PORTLAND
State	:	OR
Zip	:	97223-8023
Country	:	US
Telephone Number	:	503-639-3009
Fax Number	:	503-620-3453

Provider Business Practice Location Address
First Line	:	7180 SW FIR LOOP
Second Line	:	1A
City	:	PORTLAND
State	:	OR
Zip	:	97223-8023
Country	:	US
Telephone Number	:	503-639-3009
Fax Number	:	503-620-3453

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

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	03/09/2011

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