Provider Demographics
NPI:1164313516
Name:SACRED SALMON COMMUNITY MIDWIFERY, LLC
Entity type:Organization
Organization Name:SACRED SALMON COMMUNITY MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRIMARY MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:971-241-2085
Mailing Address - Street 1:309 SE DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6217
Mailing Address - Country:US
Mailing Address - Phone:971-241-2085
Mailing Address - Fax:971-901-3090
Practice Address - Street 1:309 SE DAYTON AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6217
Practice Address - Country:US
Practice Address - Phone:971-241-2085
Practice Address - Fax:971-901-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty