Provider Demographics
NPI:1912423328
Name:PACE, SANDRA (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1115 WOODDALE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1139
Mailing Address - Country:US
Mailing Address - Phone:502-434-8376
Mailing Address - Fax:502-473-1070
Practice Address - Street 1:363 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-3302
Practice Address - Country:US
Practice Address - Phone:270-268-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1111111OtherMENTAL HEALTH