Provider Demographics
NPI:1760718506
Name:WALSH, SARAH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17235 N 75TH AVE
Mailing Address - Street 2:E-170
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0831
Mailing Address - Country:US
Mailing Address - Phone:623-262-1934
Mailing Address - Fax:602-795-3980
Practice Address - Street 1:17235 N 75TH AVE
Practice Address - Street 2:E-170
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0831
Practice Address - Country:US
Practice Address - Phone:623-262-1934
Practice Address - Fax:602-795-3980
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist