Provider Demographics
NPI:1215262555
Name:PASTER, GRACE CHARLOTTE (SLP)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:CHARLOTTE
Last Name:PASTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KAYADEROSSERAS DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2529
Mailing Address - Country:US
Mailing Address - Phone:518-884-0424
Mailing Address - Fax:
Practice Address - Street 1:107 KAYADEROSSERAS DR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2529
Practice Address - Country:US
Practice Address - Phone:518-884-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011966-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist