Provider Demographics
NPI:1679729123
Name:PALMER, BENJAMIN H IV (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:H
Last Name:PALMER
Suffix:IV
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6890 TWIN VALLEY TER
Mailing Address - Street 2:
Mailing Address - City:ALMOND
Mailing Address - State:NY
Mailing Address - Zip Code:14804-9705
Mailing Address - Country:US
Mailing Address - Phone:607-276-2593
Mailing Address - Fax:
Practice Address - Street 1:6795 STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:ALMOND
Practice Address - State:NY
Practice Address - Zip Code:14804-9716
Practice Address - Country:US
Practice Address - Phone:607-276-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist