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

Individual provider Mental Health Counselor · NPI 1821285628

Jennifer Wallis, LCSW, CADCIII is a Mental Health Counselor in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2007.

Licensed in
OR
In the registry since
2007
Specialties on file
3
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

19500 SE Stark St
Portland, OR 97233-5757
Phone: (503) 278-0397
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence L5660 (OR)
Mental Health Counselor Taxonomy 101YM0800X
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 12-03-77 (OR)

Record details

NPI number1821285628
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW , CADCIII
Sole proprietorNo
NPI enumeratedSeptember 26, 2007
Last updated in NPPESDecember 28, 2021
Certification dateDecember 28, 2021

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