Individual
CONNIE PALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC III
Contact information
Practice address
1615 BONFORTE BLVD, PUEBLO, CO 81001-1602
(719) 404-1992
(719) 404-1996
Mailing address
1615 BONFORTE BLVD, PUEBLO, CO 81001-1602
(719) 404-1992
(719) 404-1996
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7136
CO
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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