Provider Demographics
NPI:1407992365
Name:HALBAKKEN, WANDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:
Last Name:HALBAKKEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SW CONDOR AVE APT B1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4158
Mailing Address - Country:US
Mailing Address - Phone:503-224-0606
Mailing Address - Fax:
Practice Address - Street 1:2100 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2815
Practice Address - Country:US
Practice Address - Phone:503-797-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health