Bethany Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5807 Issued in OR

Practice address

2450 Lancaster Dr NE
Salem, OR 97305-1130

Phone

(503) 783-4004

NPI assigned

Dec 3, 2007

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 names 1

• Bethany Butler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1992987754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 COMMERCIAL ST SE UNIT 4364",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973026712",
            "telephone_number": "503-783-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051130",
            "telephone_number": "503-783-4004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 Church St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973023016",
            "country_code": "US",
            "telephone_number": "503-783-4004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BETHANY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-03",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "5807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY",
            "last_name": "BUTLER",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Walker
• Rose Walker
• Tiffany Walker, NP
• Josie Mirth Wall
• Kayleen R Wall, HIS
• James Thomas Wallace, D.C.
• Natalie Erin Wallace, DO
• Crystal Walling
• Mara Marie Walls, B.S.
• Walmart Inc.

• Clinical Social Worker in Salem, OR
• Providers in Salem, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.