Provider Demographics
NPI:1760204044
Name:WILSON, SARAH MICHELLE (PPS SCHOOL PSYCHOLOG)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PPS SCHOOL PSYCHOLOG
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MICHELLE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 SCHOOL ROAD P.O. BOX 650
Mailing Address - Street 2:
Mailing Address - City:MIRANDA
Mailing Address - State:CA
Mailing Address - Zip Code:95553
Mailing Address - Country:US
Mailing Address - Phone:707-943-1789
Mailing Address - Fax:707-943-1921
Practice Address - Street 1:110 SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:MIRANDA
Practice Address - State:CA
Practice Address - Zip Code:95553
Practice Address - Country:US
Practice Address - Phone:707-943-1789
Practice Address - Fax:707-943-1921
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240125724PPS103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool