Individual
MRS. KELLY JENE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, CADCI
Contact information
Practice address
3737 PORTLAND RD NE, SALEM, OR 97301-0311
(503) 390-2600
Mailing address
3737 PORTLAND RD NE, SALEM, OR 97301-0311
(503) 390-2600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
05-11-34
OR
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/03/2008
Last updated
07/10/2019
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