Individual provider · Type 1 NPI

Mandi Danielle Wallace

Student in an Organized Health Care Education/Training Program · Portland, OR

NPI number 1992367916 Active

Practice location

32 NE 11th Ave
Portland, OR 97232-3001

Call (503) 542-7635 Map

Other practice locations

  • 8915 SW Center St, Tigard, OR 97223-6307
  • 8915 SW Center St, Tigard, OR 97223-6307

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor 101YM0800XNone listed
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1992367916

Mandi Danielle Wallace's National Provider Identifier is 1992367916, issued on Jun 29, 2019. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Portland, OR. The record was last updated on Jan 8, 2024.