Susan K Wallace IV

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

63360 NW Britta St Ste 1
Bend, OR 97701-9475

Phone

(541) 318-4845

NPI assigned

Jun 18, 2007

Sex

Female

Sole proprietor

Yes

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": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184889600000",
    "number": "1679778914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21865 BEAR CREEK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019660",
            "telephone_number": "541-318-8082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63360 NW BRITTA ST STE 1",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977019475",
            "telephone_number": "541-318-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "K",
        "name_suffix": "IV",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2007-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathleen Wallace
• Jim F Wallace, PT
• Kendall Wallace
• Michelle Wallace, LCSW
• Philip C Wallace, MD
• Austin Waller
• Jessica Wallick
• Erin M Walling, MD
• Walmart Inc.
• Walnut Vision Care Or, P.C.

• Mental Health Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2007; 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.