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General NPI Number Information
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NPI Number | 1861338303
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Entity Type | Organization
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Legal Business Name | WALLER WHOLISTIC WELLNESS & CONSULTING
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 4110 NE 122ND AVE STE 110
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City | PORTLAND
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State | OR
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Zip | 97230-1359
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Country | US
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Telephone | 503-832-0792
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Fax |
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Provider Business Mailing Address
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Address Line | 15667 SE RAINIER AVE
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City | CLACKAMAS
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State | OR
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Zip | 97015-9423
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Country | US
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Telephone | 503-544-7058
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MICHAEL WALLER
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Credential | LCSW
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Telephone | 503-544-7058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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