MEDICARE: MS. ELLEN SHEFFIELD PACE MSW, LCSW

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	1041C0700X	Clinical Social Worker	2006003135	MO

General Provider Information

NPI Number	:	1376877167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN SHEFFIELD PACE MSW, LCSW

Provider Business Mailing Address
First Line	:	30 OAKLEIGH LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1359
Country	:	US
Telephone Number	:	314-800-8929
Fax Number	:	314-968-1901

Provider Business Practice Location Address
First Line	:	231 W LOCKWOOD AVE
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2327
Country	:	US
Telephone Number	:	314-968-1900
Fax Number	:	314-968-1901

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

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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