Healthcare Provider Details

I. General information

NPI: 1114558251
Provider Name (Legal Business Name): ASHLA PACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 E FORT UNION BLVD # 1045
MIDVALE UT
84047-1800
US

IV. Provider business mailing address

6013 S REDWOOD RD
TAYLORSVILLE UT
84123-5220
US

V. Phone/Fax

Practice location:
  • Phone: 801-709-1139
  • Fax:
Mailing address:
  • Phone: 801-255-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11905784-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: