MEDICARE: SALLY WALSH LCSW

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
1	1041C0700X	Clinical Social Worker	25340	TX

General Provider Information

NPI Number	:	1346570025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY WALSH LCSW

Provider Business Mailing Address
First Line	:	1518 CRESCENT WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2770
Country	:	US
Telephone Number	:	210-452-3421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 CRESCENT WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2770
Country	:	US
Telephone Number	:	210-452-3421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2010
Last Update Date	:	01/02/2010

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Directions to “ SALLY WALSH LCSW” Practice Location

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