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General NPI Number Information
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NPI Number | 1164313516
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Entity Type | Organization
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Legal Business Name | SACRED SALMON COMMUNITY MIDWIFERY, LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 309 SE DAYTON AVE
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City | MCMINNVILLE
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State | OR
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Zip | 97128-6217
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Country | US
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Telephone | 971-241-2085
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Fax | 971-901-3090
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Provider Business Mailing Address
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Address Line | 309 SE DAYTON AVE
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City | MCMINNVILLE
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State | OR
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Zip | 97128-6217
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Country | US
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Telephone | 971-241-2085
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Fax | 971-901-3090
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Authorized Official
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Title or Position | OWNER, PRIMARY MIDWIFE
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Name | JESSICA N JOHNSON
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Credential | CPM, LDM
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Telephone | 971-241-2085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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