Individual
OWEN WALLULATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
340 NW 5TH ST, BOX 1710, REDMOND, OR 97756-1869
(541) 516-4087
(541) 504-1195
Mailing address
850 SW 4TH ST, MADRAS, OR 97741-9628
(541) 475-4822
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17 CRM 065
OR
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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