Micronesian Islander Community

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

MICRONESIAN ISLANDER COMMUNITY

Practice address

2744 12TH St SE
Salem, OR 97302-3159

Phone

(971) 209-5827

NPI assigned

Oct 30, 2024

Last updated

Oct 30, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jackie Leung, JD, MS

Title

Executive Director

Phone

(971) 209-5827

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1740002633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18606",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973058606",
            "telephone_number": "971-209-5827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2744 12TH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973023159",
            "telephone_number": "971-209-5827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICRONESIAN ISLANDER COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "LEUNG",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "971-209-5827",
        "authorized_official_credential": "JD, MS"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Michelotti
• Geary Joe Michels, D.C.
• Connie Jo Mickelson, RD, LD
• Ryan Amos Mickelson, PHARMD, BCPS
• Sean Alexander Mickelson, MS, LPC
• Mid Valley Counseling Center Inc
• Mid Valley Employees Benefit Trust
• Mid Valley Medical Home LLC (Mid Valley Physicians Home Health)
• Mid Valley SRTF LLC
• Mid-Valley Dental Associates, LLC

• Voluntary or Charitable Agency in Salem, OR
• Providers in Salem, OR by specialty
• Voluntary or Charitable Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.