Provider Demographics
NPI:1114125259
Name:PACE, MELANIE BOQUET (MCD)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:BOQUET
Last Name:PACE
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15065 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-3304
Mailing Address - Country:US
Mailing Address - Phone:985-778-8622
Mailing Address - Fax:
Practice Address - Street 1:15065 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-3304
Practice Address - Country:US
Practice Address - Phone:985-778-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1722120Medicaid