Provider Demographics
NPI:1063648442
Name:WALTER, SARAH ELAINE (BCABA , TN LABA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELAINE
Last Name:WALTER
Suffix:
Gender:F
Credentials:BCABA , TN LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:716 JACE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6012
Mailing Address - Country:US
Mailing Address - Phone:931-561-6381
Mailing Address - Fax:931-552-8834
Practice Address - Street 1:716 JACE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6012
Practice Address - Country:US
Practice Address - Phone:931-516-6381
Practice Address - Fax:931-552-8834
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-16-7214103K00000X
TN0002106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst