VICTORIA LYNN WALLACE (NPI# 1295873933) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295873933 |
| Entity Type | Individual |
| Full Name | VICTORIA LYNN WALLACE |
| Credential | CADC1,QMHA |
| Practice Address |
5643 Ne Alberta St Portland OR 97218-2557 |
| Mailing Address |
9268 Se Clinton St Portland OR 97266-1456 |
| Practice Telephone | 5033805871 |
| Mailing Telephone | 5038720483 |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| X | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952820292 | Victoria Lynn Wallace | Counselor | 79 Bonnymede Rd, Apt 104, Pueblo, CO 81001-8100 | 2017-09-19 |
| 1487075271 | Victoria Lee Wallace | Social Worker | 1314 Victoria St, Apt. 1002, Honolulu, HI 96814-1048 | 2013-12-20 |
| 1811279268 | Victoria L Wallace | Pharmacist | 405 S 8th Street, Payette, ID 83661 | 2011-09-12 |
| 1326353442 | Victoria Wallace | Social Worker | 112 Desirable Lane, Monroe, LA 71203 | 2010-08-12 |
| 1295769859 | Victoria Anne Wallace | Nurse Practitioner | 1931 Eagan Ave, Fairbanks Correctional Center, Fairbanks, AK 99701-5703 | 2006-07-10 |
| 1629386552 | Victoria Wallace | Licensed Practical Nurse | 3737 Lander Rd, Pepper Pike, OH 44124-5712 | 2010-09-14 |
| Street Address |
5643 NE ALBERTA ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97218-2557 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043852726 | Alex Margarito | Specialist/Technologist | 6801 Necornfoot Rd, Fpo, AA 97218 | 2019-10-14 |
| 1083101943 | Joyce M Larkins | Specialist | 5852 Ne 42nd Ave., Portland, OR 97218 | 2018-04-17 |
| 1740709658 | Alyssa M Cavalier | Licensed Practical Nurse | 6601 Ne 78th Ct., Suite A3, Portland, OR 97218 | 2017-09-12 |
| 1093266405 | Jean Hansen | Counselor | 6601ne 78th Court Suite, Suite A3, Portland, OR 97218 | 2016-10-20 |
| 1174913636 | Kirsten Kelly-chambers | Counselor | 4310 Ne Killinsworth Street, Portland, OR 97218 | 2015-02-04 |
| 1386962074 | Kathleen Kuhlmey Sheridan | Nurse Practitioner | 5215 Ne 52nd Ave, Portland, OR 97218 | 2010-05-06 |
| 1003049909 | Kevin Richardson | Adult Companion | 5029 Ne Killingsworth St, Portland, OR 97218 | 2009-08-26 |
| 1366676462 | Bobbi Gabriele Kennedy | Military Health Care Provider | 6801 Ne Cornfoot Road, Portland, OR 97218 | 2009-05-05 |
| 1396980751 | Jamie Mercile Taylor | Counselor | 4310 N.e Kilingsworth, Portland, OR 97218 | 2008-12-12 |
| 1902041460 | Brandi Danielle Hess | Counselor | 4450 Ne 76th, Portland, OR 97218 | 2008-12-11 |
| Find all providers in zip 97218 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163657 | Kevin Charles Reiser | Counselor | 2318 Ne Martin Luther King Blvd, Portland, OR 97212-3715 | 2020-08-03 |
| 1881203628 | Beau Curtiss | Counselor | 7916 Se Foster Rd Ste 203, Portland, OR 97206-4289 | 2020-07-28 |
| 1851916886 | Jonathan Cross | Counselor | 49 Montrose Ave Apt 3, Portland, ME 04103-2442 | 2020-06-16 |
| 1639703960 | Elizabeth Ann Anderson | Counselor | 1820 Sw Vermont St Ste J, Portland, OR 97219-1945 | 2020-02-25 |
| 1194356618 | Deforrest Kwesi Jackson | Counselor | 122 Ne 122nd Ave Ste 200, Portland, OR 97230-2103 | 2020-02-03 |
| 1760012942 | Jesse Decker | Counselor | 7015 N Boston Ave, Portland, OR 97217-5711 | 2020-01-16 |
| 1740829076 | Ryan Christianson | Counselor | 2707 Ne Flanders St, Portland, OR 97232-3159 | 2020-01-03 |
| 1083264477 | Kayla Rose Paris | Counselor | 420 Cumberland Ave, Portland, ME 04101-2823 | 2019-09-17 |
| 1275193260 | Anna Khval | Counselor | 1500 Se 122nd Ave, Portland, OR 97233-1207 | 2019-06-20 |
| 1841855301 | Portland Opioid Health Home | Counselor | 48 Free St., Mezzanine Level, Portland, ME 04101 | 2019-05-09 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.