Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blake Wallace, CSWA

Individual provider Clinical Social Worker · NPI 1518702976

Blake Wallace, CSWA is a Clinical Social Worker in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2024
Specialties on file
2

Practice location Address checks out

3500 NE Martin Luther King Jr Blvd Ste 200
Portland, OR 97212-2093
Phone: (503) 327-8205
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence A15334 (OR)
Clinical Social Worker Taxonomy 1041C0700X · Licence 24-QMHP-R-2920 (OR)

Record details

NPI number1518702976
Entity typeIndividual (Type 1)
GenderMale
Credentials CSWA
Sole proprietorYes
NPI enumeratedJune 27, 2024
Last updated in NPPESJuly 19, 2024
Certification dateJuly 19, 2024

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