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MIKE WALLACE
NPI 1881413680
Peer Specialist in Dallas, OR

Active since October 08, 2024
945 SE UGLOW AVE, DALLAS, OR 97338(503) 837-1762 Get Directions Write a Review

NPPES record last updated: October 8, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mike Wallace NPPES

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

MIKE WALLACE (NPI 1881413680) is an individual peer specialist in Dallas, Oregon, licensed in Oregon (2627) and active in the NPI registry since October 2024.

NPPES Registry Identity

NPI1881413680
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameMIKE WALLACE
Location Address945 SE UGLOW AVEDallas, OR 97338-2642
Mailing Address1170 Barnes Ave Se Apt 222Salem, OR 97306-3560 · (503) 949-1008
Phone(503) 837-1762
Sole ProprietorYes
Enumeration DateOctober 8, 2024
NPPES CertifiedOctober 8, 2024
✔ NPI 1881413680 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers
Taxonomy Code175T00000X
License✔ Licensed in OR · 2627
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
945 SE UGLOW AVE, Dallas, OR 97338
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Other Providers at the Same Location NPPES 3

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

DANIELLE J SMALLWOOD PSS
Peer Specialist
945 SE UGLOW AVE
DALLAS, OR 97338
Polk County (503) 837-1762
SHELBY WHITE PSS
Peer Specialist
945 SE UGLOW AVE
DALLAS, OR 97338
Polk County (503) 837-1762
STEPHANIE GIBSON PSS
Peer Specialist
945 SE UGLOW AVE
DALLAS, OR 97338
Polk County (503) 837-1762

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 Mike Wallace's NPI number?

The NPI number for Mike Wallace is 1881413680. It was assigned to this individual provider in the NPPES registry on October 8, 2024.

Where is Mike Wallace located?

Mike Wallace practices at 945 SE Uglow Ave, Dallas, OR 97338. The listed phone number is (503) 837-1762.

What is Mike Wallace's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

When was this NPI record last updated?

The NPPES record for Mike Wallace was last updated on October 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.