Provider Demographics
NPI:1588827661
Name:PACE, HEATHER MANGELS (SLP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MANGELS
Last Name:PACE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MANGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:150 DUNCAN ROAD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924-9037
Mailing Address - Country:US
Mailing Address - Phone:304-799-7400
Mailing Address - Fax:304-799-2776
Practice Address - Street 1:150 DUNCAN ROAD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9037
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:304-799-2776
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003931235Z00000X
WVSLP-1618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist