Individual
MICHAEL WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 NE BURNSIDE AVE, BEND, OR 97701-5122
(541) 797-0098
Mailing address
18600 SE MCLOUGHLIN BLVD, MILWAUKIE, OR 97267-6723
(503) 946-3267
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
26-CRM-5444
OR
Other
Enumeration date
06/08/2026
Last updated
06/08/2026
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