AGUSTINA WALLACE

Peer Specialist

Active Individual
NPI: 1811856339

Practice Address

1132 SW 13TH AVE
Portland, OR 97205

Phone: (503) 535-3860

Specialties

Specialty Code Primary License
Peer Specialist 175T00000X Yes 109318 (OR)

Frequently Asked Questions

NPI 1811856339 is the National Provider Identifier for AGUSTINA WALLACE, a Peer Specialist provider located in Portland, OR. This NPI was enumerated on January 20, 2026.
AGUSTINA WALLACE practices at 1132 SW 13TH AVE, Portland, OR 97205.

Quick Facts

NPI
1811856339
Type
Individual
Enumerated
Jan 20, 2026
Last Updated
Jan 20, 2026

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