Provider Demographics
NPI:1730893678
Name:WALLIN, SARA BETH (BS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:WALLIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:BETH
Other - Last Name:STALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2931 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4639
Mailing Address - Country:US
Mailing Address - Phone:928-278-8338
Mailing Address - Fax:
Practice Address - Street 1:2931 BELMONT RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4639
Practice Address - Country:US
Practice Address - Phone:928-278-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator