Provider Demographics
NPI:1629210539
Name:WALS, SARA ANN
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:WALS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 ERIC WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1325
Mailing Address - Country:US
Mailing Address - Phone:630-362-4045
Mailing Address - Fax:
Practice Address - Street 1:586 ERIC WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1325
Practice Address - Country:US
Practice Address - Phone:630-362-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist