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General NPI Number Information
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NPI Number | 1760204044
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Entity Type | Individual
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Provider Name | SARAH MICHELLE WILSON PPS SCHOOL PSYCHOLOG
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Gender | Female
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 110 SCHOOL ROAD
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City | MIRANDA
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State | CA
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Zip | 95553
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Country | US
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Telephone | 707-943-1789
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Fax | 707-943-1921
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Provider Business Mailing Address
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Address Line | 110 SCHOOL ROAD P.O. BOX 650
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City | MIRANDA
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State | CA
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Zip | 95553
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Country | US
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Telephone | 707-943-1789
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Fax | 707-943-1921
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 240125724PPS
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License Number State | CA
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