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NPI Code Detail

MEDICARE: SARAH WALLACE

MEDICARE: SARAH WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner
21041C0700XClinical Social Worker133922CA
31041C0700XClinical Social Worker112763CA

General Provider Information

NPI Number : 1013551795
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH WALLACE
Provider Business Mailing Address
First Line : 1065 BUCKS LAKE RD
Second Line :
City : QUINCY
State : CA
Zip : 95971-9599
Country : US
Telephone Number : 530-283-2121
Fax Number :
Provider Business Practice Location Address
First Line : 1065 BUCKS LAKE RD
Second Line :
City : QUINCY
State : CA
Zip : 95971-9599
Country : US
Telephone Number : 530-283-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2019
Last Update Date : 01/06/2026

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Directions to “ SARAH WALLACE ” Practice Location

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