Basic Information
| Provider Information | |||||||||
| NPI: | 1124653852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | BUCHANAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BSW, MSW, LSWAIC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BUCHANAN | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 107 S DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098384651 | ||||||||
| FaxNumber: | 5093632762 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 E SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992023125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098384651 | ||||||||
| FaxNumber: | 5093632762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2020 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CG61042075 | WA | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | NA60299721 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | CG61042075 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | SC61260204 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.