Michael Wall

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

26-CRM-5444 Issued in OR

Practice address

401 NE Burnside Ave
Bend, OR 97701-5122

Phone

(541) 797-0098

NPI assigned

Jun 8, 2026

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teen Challenge International Pacific Northwest Centers

  • Community/Behavioral Health Agency
  • Milwaukie, OR
  • NPI 1245784222
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1780876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780876800000",
    "number": "1033042023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18600 SE MCLOUGHLIN BLVD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972676723",
            "telephone_number": "503-946-3267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 NE BURNSIDE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977015122",
            "telephone_number": "541-797-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-06-08",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "26-CRM-5444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John A Walker, MD
• Kirk William Walker, M.D.
• Shelia Marie Walker
• Stacy Rae Walker, RN
• Walking Mountain Wellness LLC
• Cathleen Wallace
• Jim F Wallace, PT
• Kendall Wallace
• Michelle Wallace, LCSW
• Philip C Wallace, MD

• Peer Specialist in Bend, OR
• Providers in Bend, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.