=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093724049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM WILLARD PACE PH.D., L.P.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5851 DULUTH ST SUITE 113
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-645-3115
-----------------------------------------------------
Fax | 651-645-2752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5851 DULUTH ST SUITE 113
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-645-3115
-----------------------------------------------------
Fax | 651-645-2752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number | LP2543
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | LP2543
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------