Provider Demographics
NPI:1841566957
Name:PACE, ERIC J
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:PACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E CONGRESS PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6247
Mailing Address - Country:US
Mailing Address - Phone:815-459-3810
Mailing Address - Fax:815-356-3550
Practice Address - Street 1:411 E CONGRESS PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6247
Practice Address - Country:US
Practice Address - Phone:815-459-3810
Practice Address - Fax:815-356-3550
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist