Healthcare Provider Details

I. General information

NPI: 1376877167
Provider Name (Legal Business Name): ELLEN SHEFFIELD PACE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W LOCKWOOD AVE SUITE 201
SAINT LOUIS MO
63119-2327
US

IV. Provider business mailing address

30 OAKLEIGH LN
SAINT LOUIS MO
63124-1359
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-1900
  • Fax: 314-968-1901
Mailing address:
  • Phone: 314-800-8929
  • Fax: 314-968-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006003135
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: