Mike Wallace
Mike Wallace is a Peer Specialist in Dallas, Oregon. Practices as a sole proprietor. Licensed in Oregon.
- Licensed in
- OR
- In the registry since
- 2024
Practice location Address checks out
945 SE Uglow AveDallas, OR 97338-2642
Phone: (503) 837-1762
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X · Licence 2627 (OR) |
|---|
Record details
| NPI number | 1881413680 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | October 8, 2024 |
| Last updated in NPPES | October 8, 2024 |
| Certification date | October 8, 2024 |
| Mailing address | 1170 Barnes Ave Se Apt 222, Salem, OR 97306-3560 |
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