Provider Demographics
NPI:1306514245
Name:WALLSTEN, DANIEL MICHAEL (CSWA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:WALLSTEN
Suffix:
Gender:M
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 NW FLANDERS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5410
Mailing Address - Country:US
Mailing Address - Phone:503-568-1493
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5410
Practice Address - Country:US
Practice Address - Phone:503-427-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA147211041C0700X
ORQMHP-R101YM0800X
OR23-QMHP-R-2358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical