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JENNIFER WALLIS LCSW, CADCIII
NPI 1821285628
Social Worker - Clinical in Portland, OR

Active since September 26, 2007PECOS Enrolled
19500 SE STARK ST, PORTLAND, OR 97233(503) 278-0397 Get Directions Write a Review

NPPES record last updated: December 28, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 28, 2021, Aug 2, 2019 (2 updates tracked since 2019).

About Jennifer Wallis Lcsw, Cadciii NPPES

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

JENNIFER WALLIS LCSW, CADCIII (NPI 1821285628) is an individual clinical provider in Portland, Oregon, licensed in Oregon (L5660) and active in the NPI registry since September 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1821285628
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJENNIFER WALLISCredential: LCSW, CADCIII
Location Address19500 SE STARK STPortland, OR 97233-5757
Mailing Address19500 Se Stark StPortland, OR 97233-5757
Phone(503) 278-0397
Sole ProprietorNo
Enumeration DateSeptember 26, 2007
Last NPPES UpdateDecember 28, 20212 updates tracked since enumeration
NPPES CertifiedDecember 28, 2021
✔ NPI 1821285628 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in OR · L5660
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.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 12-03-77 (OR)
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
19500 SE STARK ST, Portland, OR 97233
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jennifer Wallis Lcsw, Cadciii 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.

Medicare Billing Reassignment

Medicare enrollment records show Jennifer Wallis reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sapphire At Gresham Rehab, LLC
2.0 mi
Skilled Nursing Facility
405 NE 5TH ST
Gresham, OR 97030
  • Reassigned Medicare billing, Oregon enrollment
  • Medicare enrollment name: Kaiser Foundation Health Plan Of The Northwest
  • 3,207 clinicians in this Medicare group
NPI 1033740899 (503) 666-5600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97233 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 20

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

MS. MEGAN LILAH MARTIN MA
Counselor (Addiction (Substance Use Disorder))
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (800) 813-2000
MS. GAYLE A NORIE GAYLE NORIE
Nurse Practitioner (Family)
19500 SE STARK ST, PORTLAND
PORTLAND, OR 97233
Multnomah County (503) 669-3900
ANNA CAREY HINZ
Student in an Organized Health Care Education/Training Program
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (800) 813-2000
KEVIN TOMLIN LPC
Counselor (Addiction (Substance Use Disorder))
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (503) 249-3434
CHRISTINA CASNAR PHD
Psychologist (Clinical)
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (503) 669-5072
SARAH K KRAKAUER CNM
Advanced Practice Midwife
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (503) 669-3900
BRIAN JOEL GOULD M.D.
Internal Medicine
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (800) 813-2000
DENISE GARCIA
Social Worker
19500 SE STARK ST
PORTLAND, OR 97233
Multnomah County (503) 669-5048

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 Jennifer Wallis's NPI number?

The NPI number for Jennifer Wallis is 1821285628. It was assigned to this individual provider in the NPPES registry on September 26, 2007.

Where is Jennifer Wallis located?

Jennifer Wallis practices at 19500 SE Stark St, Portland, OR 97233. The listed phone number is (503) 278-0397.

What is Jennifer Wallis's specialty?

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

Is Jennifer Wallis enrolled in Medicare?

Yes. Jennifer Wallis is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jennifer Wallis's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jennifer Wallis reassigns Medicare benefits to Sapphire At Gresham Rehab, LLC (Gresham, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jennifer Wallis's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jennifer Wallis was last updated on December 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.