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General NPI Number Information
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NPI Number | 1811473093
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Entity Type | Individual
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Provider Name | SARAH JAYNE WALLACE PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 300 POLARIS PKWY STE 275
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City | WESTERVILLE
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State | OH
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Zip | 43082-7989
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Country | US
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Telephone | 614-955-3828
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Fax | 614-955-3852
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Provider Business Mailing Address
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Address Line | PO BOX 7527
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City | DUBLIN
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State | OH
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Zip | 43017-0727
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08574
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License Number State | OH
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