Healthcare Provider Details

I. General information

NPI: 1053258368
Provider Name (Legal Business Name): SARAH ARLENE WALLACE M.A SCHOOL COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14181 GROVE ST, WALNUT GROVE
WALNUT GROVE CA
95690
US

IV. Provider business mailing address

1720 S HUTCHINS ST APT 8
LODI CA
95240-6137
US

V. Phone/Fax

Practice location:
  • Phone: 916-776-1844
  • Fax:
Mailing address:
  • Phone: 916-776-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: