Provider Demographics
NPI:1366737017
Name:PACHECO, ANITA (SLP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PACHECO
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 1:200 VALLEY STATION CIR
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-9587
Mailing Address - Country:US
Mailing Address - Phone:805-252-3010
Mailing Address - Fax:877-470-6398
Practice Address - Street 1:7625 PARAGON RD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4067
Practice Address - Country:US
Practice Address - Phone:877-480-6398
Practice Address - Fax:877-470-6398
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist