Individual
SARA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPA
Contact information
Practice address
11824 RANSUM DR, LOUISVILLE, KY 40243-2802
(502) 338-0608
(502) 245-1888
Mailing address
11824 RANSUM DR, LOUISVILLE, KY 40243-2802
(502) 338-0608
(502) 245-1888
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
260061
KY
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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