Provider Demographics
NPI:1689154510
Name:WALSH, MICHAEL LOUIS
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 SW ALOMA WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7919
Mailing Address - Country:US
Mailing Address - Phone:408-306-8940
Mailing Address - Fax:
Practice Address - Street 1:605 SE CESAR E CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3216
Practice Address - Country:US
Practice Address - Phone:503-231-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician