Active NPI
Felicia Aimi Wallberg
- Counselor
- Tualatin, OR
National Provider Identifier
1689138638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- R-5070
- Practice address
- 19824 SW 72ND Ave Ste 102
Tualatin, OR 97062-8398 - Phone
- (503) 773-8600
- NPI assigned
- Jan 24, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | R-5070 | OR | Primary |
Addresses
Primary practice location
19824 SW 72ND Ave Ste 102
Tualatin, OR 97062-8398
Mailing address
13823 NW Mill Creek Dr
Portland, OR 97229-5722
Phone (503) 421-1919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-5070 | OR | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1689138638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13823 NW MILL CREEK DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972295722",
"telephone_number": "503-421-1919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19824 SW 72ND AVE STE 102",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970628398",
"telephone_number": "503-773-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLBERG",
"first_name": "FELICIA",
"middle_name": "AIMI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-24",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "R-5070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tualatin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.