Provider Demographics
NPI:1710471297
Name:PACE, AMANDA LAUREN (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LAUREN
Last Name:PACE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 S I 10 SERVICE RD W STE 110
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1224
Mailing Address - Country:US
Mailing Address - Phone:504-454-3277
Mailing Address - Fax:
Practice Address - Street 1:3434 HOUMA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4278
Practice Address - Country:US
Practice Address - Phone:504-454-3277
Practice Address - Fax:504-887-8934
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8112237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter