Provider Demographics
NPI:1801094859
Name:PACELY, LATIA Y (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LATIA
Middle Name:Y
Last Name:PACELY
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HOLMAN ST # A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4240
Mailing Address - Country:US
Mailing Address - Phone:832-561-3667
Mailing Address - Fax:832-201-8214
Practice Address - Street 1:2106 HOLMAN ST # A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4240
Practice Address - Country:US
Practice Address - Phone:832-561-3667
Practice Address - Fax:832-201-8214
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3128258-01Medicaid
TX3128258-02Medicaid