Kari Ann Wallace
Individual provider Active NPI Counselor · South Beach, OR
NPI 1063298552 · NPPES record last updated Aug 31, 2023
Key facts
- NPI
- 1063298552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 4360 SE Harborton St
South Beach, OR 97366-9696 - Phone
- (541) 270-8919
- NPI assigned
- Aug 31, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
4360 SE Harborton St
South Beach, OR 97366-9696
Mailing address
PO Box 52
Newport, OR 97365-0005
Phone (541) 270-8919
Other providers in South Beach, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.