Provider Demographics
NPI:1699914754
Name:PACE, SALVATORE ANTHONY (MED, CCC, SLP)
Entity type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:ANTHONY
Last Name:PACE
Suffix:
Gender:M
Credentials:MED, CCC, SLP
Other - Prefix:MR
Other - First Name:SAL
Other - Middle Name:A
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6411
Mailing Address - Country:US
Mailing Address - Phone:781-862-8529
Mailing Address - Fax:
Practice Address - Street 1:9 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6411
Practice Address - Country:US
Practice Address - Phone:781-862-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist