Healthcare Provider Details

I. General information

NPI: 1487562989
Provider Name (Legal Business Name): JADE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 W CLEARWATER AVE
KENNEWICK WA
99336-8613
US

IV. Provider business mailing address

11225 DUNSMUIR DR
PASCO WA
99301-6363
US

V. Phone/Fax

Practice location:
  • Phone: 509-378-5553
  • Fax:
Mailing address:
  • Phone: 509-907-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70167272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: