Healthcare Provider Details

I. General information

NPI: 1104744747
Provider Name (Legal Business Name): MAIKALANI SALLEE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 CITATION WAY STE 102
MEDFORD OR
97504-9022
US

IV. Provider business mailing address

3709 CITATION WAY STE 102
MEDFORD OR
97504-9022
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9744
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: