Healthcare Provider Details

I. General information

NPI: 1093724049
Provider Name (Legal Business Name): WILLIAM WILLARD PACE PH.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 DULUTH ST SUITE 113
GOLDEN VALLEY MN
55422-3946
US

IV. Provider business mailing address

5851 DULUTH ST SUITE 113
GOLDEN VALLEY MN
55422-3946
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-3115
  • Fax: 651-645-2752
Mailing address:
  • Phone: 651-645-3115
  • Fax: 651-645-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP2543
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP2543
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: