Provider Demographics
NPI:1386269892
Name:PALMER, KATIE ALEXANDRA (AUD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ALEXANDRA
Last Name:PALMER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44320 PREMIER PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5077
Mailing Address - Country:US
Mailing Address - Phone:703-723-8727
Mailing Address - Fax:703-723-9787
Practice Address - Street 1:44320 PREMIER PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5077
Practice Address - Country:US
Practice Address - Phone:703-723-8727
Practice Address - Fax:703-723-9787
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001778231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2201001778OtherLICENSE AUDIOLOGIST