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

Mike Wallace

Individual provider Peer Specialist · NPI 1881413680

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 Ave
Dallas, OR 97338-2642
Phone: (503) 837-1762
Show map & directions

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 number1881413680
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 8, 2024
Last updated in NPPESOctober 8, 2024
Certification dateOctober 8, 2024
Mailing address1170 Barnes Ave Se Apt 222, Salem, OR 97306-3560

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