Individual provider · Type 1 NPI
Michael Waller
Clinical Social Worker · Portland, OR
Practice location
4110 NE 122nd Ave Ste 110
Portland, OR 97230-1359
Mailing address
501 N Dixon St
Portland, OR 97227-1804
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Social Worker Primary | 1041C0700X | L17560 (OR) |
Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…
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About NPI 1760360531
Michael Waller's National Provider Identifier is 1760360531, issued on Aug 21, 2025. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Portland, OR. The record was last updated on May 18, 2026.