Provider Demographics
NPI:1497256036
Name:PACE, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 ESTATES DR STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2353
Mailing Address - Country:US
Mailing Address - Phone:916-749-4646
Mailing Address - Fax:916-749-4520
Practice Address - Street 1:214 ESTATES DR STE A
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2353
Practice Address - Country:US
Practice Address - Phone:916-749-4646
Practice Address - Fax:916-749-4520
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-34604103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst