Provider Demographics
NPI:1144782350
Name:MACE, SCOTT (HIS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:MACE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12527 GOTHAM DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6110
Mailing Address - Country:US
Mailing Address - Phone:832-567-2328
Mailing Address - Fax:
Practice Address - Street 1:204 WOODHEW DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6529
Practice Address - Country:US
Practice Address - Phone:832-567-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80792237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist