Provider Demographics
NPI:1942957501
Name:MACE, SARAH PAULINE WATKINS (PH D, ED S)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:PAULINE WATKINS
Last Name:MACE
Suffix:
Gender:F
Credentials:PH D, ED S
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:PAULINE
Other - Last Name:WATKINS MACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:245 GREENVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9797
Mailing Address - Country:US
Mailing Address - Phone:316-633-3059
Mailing Address - Fax:
Practice Address - Street 1:245 GREENVALLEY DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9797
Practice Address - Country:US
Practice Address - Phone:316-633-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3798944628103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool