Provider Demographics
NPI:1043581424
Name:PALMER, WYGELIA E (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:WYGELIA
Middle Name:E
Last Name:PALMER
Suffix:
Gender:F
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:PO BOX 1854
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 RAST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2595
Practice Address - Country:US
Practice Address - Phone:803-972-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4730235Z00000X
GASLP007680235Z00000X
NC9689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist