MEDICARE: MS. RACHEL J WALLACE

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	374J00000X	Doula	117296	OR

General Provider Information

NPI Number	:	1215869458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL J WALLACE

Provider Business Mailing Address
First Line	:	609 NE BAKER ST STE 110
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-4946
Country	:	US
Telephone Number	:	971-599-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 NE BAKER ST STE 110
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-4946
Country	:	US
Telephone Number	:	971-599-8590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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