Individual provider · Type 1 NPI

Susan K. Wallace Iv

Mental Health Counselor · Bend, OR

NPI number 1679778914 Active

Practice location

63360 NW Britta St Ste 1
Bend, OR 97701-9475

Call (541) 318-4845 Map

Mailing address

21865 Bear Creek Rd
Bend, OR 97701-9660

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1679778914

Susan K. Wallace Iv's National Provider Identifier is 1679778914, issued on Jun 18, 2007. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Bend, OR. The record was last updated on Jul 20, 2007.