MEDICARE: WALLER WHOLISTIC WELLNESS & CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861338303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLER WHOLISTIC WELLNESS & CONSULTING

Provider Business Mailing Address
First Line	:	15667 SE RAINIER AVE
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-9423
Country	:	US
Telephone Number	:	503-544-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 NE 122ND AVE STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-1359
Country	:	US
Telephone Number	:	503-832-0792
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MICHAEL WALLER
Credential	:	LCSW
Telephone Number	:	503-544-7058

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

Similar Medicare Providers

1760360531 — MICHAEL WALLER
Practice Location Address:

4110 NE 122ND AVE STE 110
PORTLAND, OR
97230-1359

Practice Phone: 503-832-0792
Practice Fax:

1609030451 — MRS. ANA REICHELT MA
Practice Location Address:

4110 NE 122ND AVE STE 102
PORTLAND, OR
97230-1359

Practice Phone: 503-309-1779
Practice Fax:

1104285154 — RICHARD FREITAG LMT
Practice Location Address:

1359 NE 35TH AVE
PORTLAND, OR
97232-1941

Practice Phone: 503-389-5545
Practice Fax:

1326516238 — DR. JASMIN MEDEIROS DC
Practice Location Address:

1359 NE 35TH AVE
PORTLAND, OR
97232-1941

Practice Phone: 503-717-6538
Practice Fax: 888-847-1238

1033217609 — DR. KATHY COLLEEN SNELLGROVE D.C.
Practice Location Address:

1359 NE 35TH AVENUE
PORTLAND, OR
97232-1941

Practice Phone: 503-232-7460
Practice Fax: 503-232-0203

1609092899 — KC SNELLGROVE
Practice Location Address:

1359 NE 35TH AVE
PORTLAND, OR
97232-1941

Practice Phone: 503-232-7460
Practice Fax: 503-232-0203

Directions to “WALLER WHOLISTIC WELLNESS & CONSULTING ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.