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NPI Code Detail

MEDICARE: SHAWNTELL NICOLE PACE PHD

MEDICARE: SHAWNTELL NICOLE PACE PHD
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
1103TC0700XClinical Psychologist5316-57WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992505358
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWNTELL NICOLE PACE PHD
Provider Business Mailing Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-777-7700
Fax Number : 414-955-0114
Provider Business Practice Location Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-777-7700
Fax Number : 414-955-0114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2025
Last Update Date : 03/17/2026

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Directions to “ SHAWNTELL NICOLE PACE PHD” Practice Location

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