Amanda Rochelle Wallace

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

885 NW Grant Ave
Corvallis, OR 97330-4578

Phone

(541) 752-2703

Fax

(541) 368-7690

NPI assigned

Mar 14, 2025

Sex

Female

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

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

{
    "created_epoch": "1741910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1245030659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 NW GRANT AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973304578",
            "telephone_number": "541-752-2703",
            "fax_number": "541-368-7690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 NW GRANT AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973304578",
            "telephone_number": "541-752-2703",
            "fax_number": "541-368-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "ROCHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-14",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Walker, MS, MAC, LPC
• Daphany Walker
• Justin Andrew Walker
• Tracey Leigh Walker, LMT
• Allison Wallace
• Marie M Wallace
• Herschel D Wallen, M.D.
• Walmart Inc.
• Jeffrey David Walpole
• Carol Walsh, RD

• Addiction (Substance Use Disorder) Counselor in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.