Individual
SARA N WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
111 W 2ND ST, PRATT, KS 67124-2644
(620) 672-6168
(620) 672-6168
Mailing address
111 W 2ND ST, PRATT, KS 67124-2644
(620) 672-6168
(620) 672-6168
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4198
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098120A
—
KS
Enumeration date
11/21/2008
Last updated
03/17/2018
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