Individual
MR. LOUIS CARL WACKERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW
Contact information
Practice address
4805 NE GLISAN, 3M16, PORTLAND, OR 97225
(503) 295-1804
Mailing address
BOX 408, 7327 SW BARNES RD, PORTLAND, OR 97225
(503) 295-1804
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0186
OR
Other
Enumeration date
05/25/2010
Last updated
05/25/2010
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