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 1:4600 LAKE BOONE TR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-787-1374
Mailing Address - Fax:919-571-8135
Practice Address - Street 1:4600 LAKE BOONE TR
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-787-1374
Practice Address - Fax:919-571-8135
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001778231H00000X
NC15622231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2201001778OtherLICENSE AUDIOLOGIST