Active NPI
Louis Carl Wackerle, MSSW
- Clinical Social Worker
- Portland, OR
National Provider Identifier
1174842512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0186
- Practice address
- 4805 NE Glisan
3M16
Portland, OR 97225 - Phone
- (503) 295-1804
- NPI assigned
- May 25, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0186 | OR | Primary |
Addresses
Primary practice location
4805 NE Glisan
3M16
Portland, OR 97225
Mailing address
Box 408
7327 SW Barnes Rd
Portland, OR 97225
Phone (503) 295-1804
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0186 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274745600000",
"number": "1174842512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BOX 408",
"address_2": "7327 SW BARNES RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-295-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN",
"address_2": "3M16",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-295-1804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WACKERLE",
"first_name": "LOUIS",
"middle_name": "CARL",
"name_prefix": "Mr.",
"credential": "MSSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-25",
"last_updated": "2010-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "0186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.