Healthcare Provider Details

I. General information

NPI: 1598655086
Provider Name (Legal Business Name): EASTSIDE RIVERS WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16125 JUANITA WOODINVILLE WAY NE UNIT 901
BOTHELL WA
98011-9431
US

IV. Provider business mailing address

11410 NE 124TH ST # 574
KIRKLAND WA
98034-4305
US

V. Phone/Fax

Practice location:
  • Phone: 206-883-6049
  • Fax:
Mailing address:
  • Phone: 206-883-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SALOME BOHNE
Title or Position: CEO
Credential:
Phone: 206-883-6049