Individual
MICHAEL WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4110 NE 122ND AVE STE 110, PORTLAND, OR 97230-1359
(503) 832-0792
Mailing address
501 N DIXON ST, PORTLAND, OR 97227-1804
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L17560
OR
1041S0200X
School Social Worker
Primary
—
—
Other
Enumeration date
08/21/2025
Last updated
05/18/2026
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