Individual
CONNIE JO MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
2600 CENTER ST NE, SALEM, OR 97301-2669
(503) 945-2800
Mailing address
2300 INDEPENDENCE HWY, INDEPENDENCE, OR 97351-9438
(503) 910-5400
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
OR
Other
Enumeration date
03/06/2020
Last updated
03/06/2020
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