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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BLAKE WALLACE LCSW
NPI 1518702976
Social Worker - Clinical in Portland, OR

Active since June 27, 2024PECOS Enrolled
3500 NE MARTIN LUTHER KING JR BLVD STE 200, PORTLAND, OR 97212(503) 327-8205(503) 254-4882 Get Directions Write a Review

NPPES record last updated: August 10, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Aug 10, 2026, Jul 19, 2024, Jul 1, 2024 and 1 more (4 updates tracked since 2024).

About Blake Wallace Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAKE WALLACE LCSW (NPI 1518702976) is an individual clinical provider in Portland, Oregon, licensed in Oregon (L18555) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1518702976
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameBLAKE WALLACECredential: LCSW
Location Address3500 NE MARTIN LUTHER KING JR BLVD STE 200Portland, OR 97212-2093
Mailing Address3500 Ne Martin Luther King Jr Blvd Ste 200Portland, OR 97212-2093 · (503) 327-8205
Phone(503) 327-8205
Fax(503) 254-4882
Sole ProprietorYes
Enumeration DateJune 27, 2024
Last NPPES UpdateAugust 10, 20264 updates tracked since enumeration
NPPES CertifiedAugust 10, 2026
✔ NPI 1518702976 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Licenses✔ Licensed in OR · L18555✔ Licensed in OR · A15334✔ Licensed in OR · 24-QMHP-R-2920
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
3500 NE MARTIN LUTHER KING JR BLVD STE 200, Portland, OR 97212
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Blake Wallace Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97212 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $58.99 – $176.88
Typical copayment $0.00 (range $14.74 – $44.22)
Most-billed visit code NA
Established Patient
$73.28 typical visit price
range $19.32 – $144.79
Typical copayment $18.32 (range $4.83 – $36.19)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIANA MARIN DURAN
Social Worker
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (503) 327-8205
ANYA GABRIELLE CREA VANCE LPC-C7301
Counselor (Professional)
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (503) 327-8205
JILLIAN WALSH LPCA
Counselor (Professional)
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (503) 327-8205
MARY CHAKHTOURA
Social Worker (Clinical)
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (503) 327-8205
JOSHUA LAMONT ALLEN LCSW
Counselor (Mental Health)
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (503) 327-8205
ERIC NARAMORE LMFT
Marriage & Family Therapist
3500 NE MARTIN LUTHER KING JR BLVD STE 200
PORTLAND, OR 97212
Multnomah County (551) 427-0332

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Blake Wallace's NPI number?

The NPI number for Blake Wallace is 1518702976. It was assigned to this individual provider in the NPPES registry on June 27, 2024.

Where is Blake Wallace located?

Blake Wallace practices at 3500 NE Martin Luther King Jr Blvd Ste 200, Portland, OR 97212. The listed phone number is (503) 327-8205.

What is Blake Wallace's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Blake Wallace enrolled in Medicare?

Yes. Blake Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Blake Wallace was last updated on August 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 52 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.