Provider Demographics
NPI:1679077523
Name:PACEJKA, ESPERANZA CORDERO (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:CORDERO
Last Name:PACEJKA
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 1:338 K ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3562
Mailing Address - Country:US
Mailing Address - Phone:801-577-8854
Mailing Address - Fax:
Practice Address - Street 1:471 HERITAGE PARK BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-217-3390
Practice Address - Fax:844-854-4658
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10664277-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist