Provider Demographics
NPI:1538417282
Name:PALMER, DEREK (MA, CCC-SLP, BCS-S)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:MA, CCC-SLP, BCS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 S MARYLAND AVE
Mailing Address - Street 2:DCAM 4517, MC9020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1426
Mailing Address - Country:US
Mailing Address - Phone:773-702-4004
Mailing Address - Fax:
Practice Address - Street 1:5758 S MARYLAND AVE
Practice Address - Street 2:DCAM 4517, MC9020
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-702-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist