Provider Demographics
NPI:1871160986
Name:WALBORN, SARAH K (ICBD, CLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:WALBORN
Suffix:
Gender:F
Credentials:ICBD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 MONTANA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2421
Mailing Address - Country:US
Mailing Address - Phone:313-408-6657
Mailing Address - Fax:915-975-9008
Practice Address - Street 1:2829 MONTANA AVE STE 207
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2421
Practice Address - Country:US
Practice Address - Phone:313-408-6657
Practice Address - Fax:915-975-9008
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
140094OtherICEA
325826OtherALPP