Kathryn Grace Waller, M.S., CFY-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

016634 Issued in OR

Practice address

8643 NE Beech St
Portland, OR 97220-5012

Phone

(503) 256-2151

NPI assigned

Oct 24, 2019

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1571875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1386287100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE STE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8643 NE BEECH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205012",
            "telephone_number": "503-256-2151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5330 NE Prescott St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972182158",
            "country_code": "US",
            "telephone_number": "503-288-6585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KATHRYN",
        "middle_name": "GRACE",
        "credential": "M.S., CFY-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-24",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "016634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE CONDITIONAL SLP LICENSE",
            "identifier": "016634",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Wallenberg, M.D.
• Daniel Wallenslager, PHARMD
• Olivia R Waller Setniker
• Waller Wholistic Wellness & Consulting
• Chris Waller
• Michael Waller
• Nancy Jane Waller, CRNFA
• Tracie Walliker, LMT
• Megan E Wallin, QMHA-I
• Grace Bailey Wallingford, RD

• Speech-Language Pathologist in Portland, OR
• Providers in Portland, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; 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.