Provider Demographics
NPI:1952537367
Name:PACE, SARA E (LISW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:PACE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:75 E WILSON BRIDGE RD STE C6
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2362
Mailing Address - Country:US
Mailing Address - Phone:614-420-2944
Mailing Address - Fax:614-573-0501
Practice Address - Street 1:75 E WILSON BRIDGE RD STE C6
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2362
Practice Address - Country:US
Practice Address - Phone:614-420-2944
Practice Address - Fax:614-573-0501
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 08000521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH446771Medicare PIN