MEDICARE: MRS. LATIA Y PACELY M.S., CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	102090	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801094859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATIA Y PACELY M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	2106 HOLMAN ST # A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4240
Country	:	US
Telephone Number	:	832-561-3667
Fax Number	:	832-201-8214

Provider Business Practice Location Address
First Line	:	2106 HOLMAN ST # A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4240
Country	:	US
Telephone Number	:	832-561-3667
Fax Number	:	832-201-8214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	08/14/2013

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Directions to “ MRS. LATIA Y PACELY M.S., CCC/SLP” Practice Location

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