Provider Demographics
NPI:1689707531
Name:WALTON, SANDRA K (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 EDINBURGH CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5112
Mailing Address - Country:US
Mailing Address - Phone:972-250-1021
Mailing Address - Fax:972-250-1021
Practice Address - Street 1:2222 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4183
Practice Address - Country:US
Practice Address - Phone:972-964-3214
Practice Address - Fax:972-964-3044
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611441Medicare ID - Type Unspecified