Provider Demographics
NPI:1245732544
Name:CHASE, WALTER IRVING
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:IRVING
Last Name:CHASE
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 1:16410 SE 5TH ST APT A2
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9569
Mailing Address - Country:US
Mailing Address - Phone:503-475-4302
Mailing Address - Fax:
Practice Address - Street 1:3311 NE MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2086
Practice Address - Country:US
Practice Address - Phone:503-946-3484
Practice Address - Fax:503-331-2549
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor