Healthcare Provider Details

I. General information

NPI: 1578853974
Provider Name (Legal Business Name): MEGHAN ELIZABETH PACE-SLOT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAN PACE

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 STONELEIGH RD
BLOOMFIELD HILLS MI
48302
US

IV. Provider business mailing address

4364 PINE TREE TRL
BLOOMFIELD HILLS MI
48302
US

V. Phone/Fax

Practice location:
  • Phone: 248-462-5561
  • Fax: 248-646-2959
Mailing address:
  • Phone: 248-462-5561
  • Fax: 248-844-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: