MRS. KELLY JENE MACK (NPI# 1164692455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164692455 |
| Entity Type | Individual |
| Full Name | MRS. KELLY JENE MACK |
| Credential | BS, CADCI |
| Practice Address |
3737 Portland Rd Ne Salem OR 97301-0311 |
| Practice Telephone | 5033902600 |
| Mailing Telephone | 5033902600 |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2019-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
05-11-34 | OR | Behavioral Health & Social Service Providers |
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578896460 | Kelly Mack | Speech-Language Pathologist | 2124 16th St, Boulder, CO 80302-4354 | 2009-09-10 |
| 1215184056 | Kelly Mack | Physical Therapist | 107 Holly Creek Dr, Irmo, SC 29063-8918 | 2008-08-23 |
| 1780702472 | Kelly Wade Mack | Dentist | 2200 Horseshoe Ln, Longview, TX 75605-5648 | 2007-03-27 |
| 1396813960 | Kelly Leigh Mack | Physician Assistant | 995 N. Prince Frederick Blvd, Suite 204, Prince Frederick, MD 20678 | 2006-12-01 |
| 1003468273 | Kelly Lynne Mack | Nurse Practitioner | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-07-09 |
| 1972933646 | Kelly Mack | Physical Therapy Assistant | 44480 W Honeycutt Rd, #106, Maricopa, AZ 85138-2903 | 2013-11-17 |
| 1457471542 | Kelly S Mack | Nurse Practitioner | 6001 Research Park Blvd, Madison, WI 53719 | 2007-03-30 |
| 1982742888 | Kelly C Mack | Nurse Practitioner | 1800 Williams St, Suite 200, Denver, CO 80218-1234 | 2007-02-02 |
| 1245308899 | Kelly Anne Mack | Dental Hygienist | 55 E Loop Rd, Grove Dental Assoc Suite 201, Wheaton, IL 60187 | 2006-12-01 |
| Street Address |
3737 PORTLAND RD NE |
| City | SALEM |
| State | OR |
| Zip Code | 97301-0311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689890493 | Marcus Eric Berglund | Marriage & Family Therapist | 3737 Portland Rd Ne, Salem, OR 97303-2511 | 2007-04-18 |
| 1841824240 | Paola Ramirez Del Valle | Community Health Worker | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2020-02-25 |
| 1255962684 | Loren Calkins | Marriage & Family Therapist | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2020-02-04 |
| 1659939791 | Laurel Becker | Counselor | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2019-06-04 |
| 1386202067 | Patricia Duncan | Counselor | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2019-05-29 |
| 1992264311 | Valerie Edwards | Case Manager/Care Coordinator | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2019-03-15 |
| 1487146239 | Hector Virgen-marquez | Case Manager/Care Coordinator | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2018-06-06 |
| 1669964680 | Mark Beach | Behavior Technician | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2018-06-05 |
| 1780180141 | Kimberly J Moore | Respite Care | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2018-04-04 |
| 1073019436 | Tracy L Young | Respite Care | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2018-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336755586 | Emma Theresa Cox | Case Manager/Care Coordinator | 33 Upham St Apt 3, Salem, MA 01970-2460 | 2020-09-22 |
| 1407475064 | Yolanda Loyer | Case Manager/Care Coordinator | 2789 E State St Ste 7, Salem, OH 44460-9327 | 2020-04-14 |
| 1770121501 | Stacy Bush Phillips | Case Manager/Care Coordinator | 1501 Mill Race Dr, Salem, VA 24153-3137 | 2019-12-11 |
| 1528618659 | Linda Diane Pierce | Case Manager/Care Coordinator | 1724 Broadway St Ne, Salem, OR 97301-0509 | 2019-09-20 |
| 1770002271 | Traci L Lee | Case Manager/Care Coordinator | 3876 Beverly Ave Bldg G, Salem, OR 97305 | 2017-09-15 |
| 1427576065 | Katherine Lingmai | Case Manager/Care Coordinator | 1790 23rd St. Ne, Salem, OR 97301 | 2017-09-04 |
| 1225577240 | Anjalique Benham | Case Manager/Care Coordinator | 5 Lancelot Ct, Apt#1, Salem, NH 03079-3555 | 2017-02-23 |
| 1518409762 | Melissa Ward | Case Manager/Care Coordinator | 1380 Southside Dr, Suite 100, Salem, VA 24153 | 2016-11-04 |
| 1467810945 | Carl Walton Kapocias | Case Manager/Care Coordinator | 750 Front St Ne, Salem, OR 97301-1089 | 2016-01-29 |
| 1215339361 | Kaylor Ficklin | Case Manager/Care Coordinator | 188 E 300 S, Salem, UT 84653-9453 | 2014-09-19 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.