MEDICARE: TIFFANY 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
1	1041C0700X	Clinical Social Worker	PCSW-918	WY

General Provider Information

NPI Number	:	1811594492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY PALMER

Provider Business Mailing Address
First Line	:	1010 E 1ST ST STE A
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2753
Country	:	US
Telephone Number	:	307-234-9979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 E 1ST ST STE A
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2753
Country	:	US
Telephone Number	:	307-234-9979
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “ TIFFANY PALMER ” Practice Location

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