MEDICARE: MS. MARA PALMER ED.S., NCSP

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	103TS0200X	School Psychologist		IL

General Provider Information

NPI Number	:	1851809594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARA PALMER ED.S., NCSP

Provider Business Mailing Address
First Line	:	8916 178TH ST
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60487-6148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 LARAMIE AVE
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1325
Country	:	US
Telephone Number	:	708-687-3334
Fax Number	:

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

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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