Provider Demographics
NPI:1942948781
Name:PALMER, LILY ELIZABETH (MED)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:ELIZABETH
Last Name:PALMER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:ELIZABETH
Other - Last Name:WEDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 N STATE ROAD 198
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2825 E COTTONWOOD PKWY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7055
Practice Address - Country:US
Practice Address - Phone:714-814-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131282432506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst