JENNIFER LYN WALLACE (NPI# 1730154154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730154154 |
| Entity Type | Individual |
| Full Name | JENNIFER LYN WALLACE |
| Credential | MD |
| Practice Address |
1235 Se Division St Suite 208 Portland OR 97202-1099 |
| Practice Telephone | 8884801115 |
| Mailing Telephone | 8884801115 |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2008-03-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD24427 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 232919 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968440 | Jennifer Wallace | Technician/Technologist | 2041 E 3rd Dr, Mesa, AZ 85204-1401 | 2020-07-06 |
| 1497249882 | Jennifer Laird Wallace | Licensed Practical Nurse | 4468 Duff Rd, Livingston, TX 77351-5627 | 2018-06-19 |
| 1124579602 | Jennifer Marie Wallace | Acupuncturist | 237 Avenida Del Norte, Redondo Beach, CA 90277-5702 | 2016-10-19 |
| 1174926984 | Jennifer Wallace | Specialist/Technologist | 806 Patton Chapel Trl, Hoover, AL 35226-2254 | 2014-10-07 |
| 1295083897 | Jennifer Wallace | Psychologist | 4226 Green Lake Rd, West Bloomfield, MI 48323-1139 | 2012-08-29 |
| 1669799086 | Jennifer Renea Wallace | Counselor | 3802 W University Blvd Apt 8104, Durant, OK 74701-3047 | 2010-04-24 |
| 1306035431 | Jennifer L Wallace | Physical Therapist | 3891 50th Ave S, Saint Petersburg, FL 33711-4811 | 2007-10-15 |
| 1316974058 | Jennifer Wallace | Speech-Language Pathologist | 1901 Century Blvd Ne Ste 20, Atlanta, GA 30345-3300 | 2006-06-27 |
| 1992766570 | Jennifer P Wallace | Specialist | 64400 E 26th Ct, Byers, CO 80103-8539 | 2006-03-31 |
| 1699760934 | Jennifer L Wallace | Internal Medicine | 7720 Jones Maltsberger, Suite 110, San Antonio, TX 78216 | 2005-09-13 |
| Street Address |
1235 SE DIVISION ST SUITE 208 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97202-1099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124563440 | Aria Walker, Lac | Clinic/Center | 1235 Se Division St, Suite 206, Portland, OR 97202-1099 | 2016-12-21 |
| 1891152047 | Ryan D Grassmann | Counselor | 1235 Se Division St, Suite 207, Portland, OR 97202-1099 | 2016-01-19 |
| 1760857668 | Sibyl Amber Voelker | Acupuncturist | 1235 Se Division St, Suite 206, Portland, OR 97202-1099 | 2015-12-04 |
| 1619340742 | Juliann Adele Squires | Massage Therapist | 1235 Se Division St, Suite 206, Portland, OR 97202-1099 | 2015-11-11 |
| 1700257292 | Mauri Danielle Castle Myers | Marriage & Family Therapist | 1235 Se Division St, Suite 111, Portland, OR 97202-1099 | 2015-10-09 |
| 1881011310 | Jennifer Thomas | Speech-Language Pathologist | 1235 Se Division St, Suite 204, Portland, OR 97202-1099 | 2014-03-21 |
| 1609291269 | Marsha Sharyn Cristales-fontaine | Counselor | 1235 Se Division St, Portland, OR 97202-1099 | 2014-02-19 |
| 1174950455 | Meghan A Marty | Psychologist | 1235 Se Division St, Ste 115, Portland, OR 97202-1085 | 2013-10-02 |
| 1013260868 | Nora Grod Lac LLC | Acupuncturist | 1235 Se Division St, Ste 106a, Portland, OR 97202-1042 | 2012-10-17 |
| 1003188418 | Monicka April Koneski | Massage Therapist | 1235 Se Division St, Suite 203b, Portland, OR 97202-1099 | 2012-01-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073143442 | Carewell LLC | Counselor | Portland River Park Center, 205 Se Spokane St Suite 358, Portland, OR 97202 | 2020-01-24 |
| 1588226765 | Melissa Lynn Hartley | Counselor | 1235 Se Division St. Suite 103, Portland, OR 97202 | 2019-07-08 |
| 1275192999 | Kimberly Rae Kilgore | Counselor | 5509 Se 22nd St #3a, Portland, OR 97202 | 2019-06-06 |
| 1639736069 | Kyra Steinhauer | Social Worker | 3145 Se Powell Blvd, Portland, OR 97202 | 2019-05-21 |
| 1134644321 | Bridgette Hennigsen | Social Worker | 3810 Se 11th Ave, Portland, OR 97202 | 2017-08-08 |
| 1558895789 | Lenore Cangeloso | Acupuncturist | 1235 Se Division Street, Suie 117, Portland, OR 97202 | 2017-04-14 |
| 1376099093 | Anna Christine Leclerc | Contractor | 2024 Se Clinton Street, Zenana Spa and Wellness Center, Portland, OR 97202 | 2016-09-01 |
| 1144684663 | Catholic Charities | Case Management | 2740 Se Powell Blvd., Portland, OR 97202 | 2016-04-11 |
| 1881082097 | Zoomcare Dental, P.C. | Dentist | 3130 Se Division Street, Building 2, Portland, OR 97202 | 2014-12-23 |
| 1124424700 | Jessica Nash | Counselor | 6411 Se 17th Ave, Portland, OR 97202 | 2014-11-10 |
| Find all providers in zip 97202 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639710783 | Christine Elizabeth O'connor | Family Medicine | 6336 Se 61st Ave, Portland, OR 97206-6718 | 2019-09-30 |
| 1427608645 | Carehere LLC | Family Medicine | Carehere Clinic- Nasg Portland, Tn, 160 Kirby Drive, Portland, TN 37148 | 2019-09-19 |
| 1063064285 | Victoria A Deane | Family Medicine | 37 Fall Brook St, Portland, ME 04103-4224 | 2019-07-09 |
| 1598238214 | Whole Systems Healthcare | Family Medicine | 1020 Sw Taylor St Ste 340, Portland, OR 97205-2508 | 2019-01-04 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1871943159 | Micah Kiehl | Family Medicine | 4427 Ne Fremont St, Portland, OR 97213-1153 | 2016-06-16 |
| 1083068589 | Carrie Lynn Binder | Family Medicine | 1035 Nw Northrup St, Portland, OR 97209-3017 | 2016-04-20 |
| 1437513835 | Kayce A Spear | Family Medicine | 10803 Se Cherry Blossom Drive, Portland, OR 97216-3107 | 2016-04-12 |
| 1992175509 | Lone Star Evaluations Inc. | Family Medicine | 1500 Wildcat Dr Ste M, Portland, TX 78374-2826 | 2015-09-25 |
| 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.