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

Earnest Wallace III, PSS

Individual provider Peer Specialist · NPI 1730927815

Earnest Wallace III, PSS is a Peer Specialist in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2024

Practice location Address checks out

5201 SW Westgate Dr Ste 100
Portland, OR 97221-2424
Phone: (469) 297-0096
Show map & directions

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

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X · Licence 111712 (OR)

Record details

NPI number1730927815
Entity typeIndividual (Type 1)
GenderMale
Credentials PSS
Sole proprietorYes
NPI enumeratedJuly 15, 2024
Last updated in NPPESJuly 15, 2024
Certification dateJuly 15, 2024

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