Healthcare Provider Details

I. General information

NPI: 1699337097
Provider Name (Legal Business Name): JESSICA PADILLA-BUENO CO 60904317
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N 20TH AVE
PASCO WA
99301-3393
US

IV. Provider business mailing address

1906 N 20TH AVE
PASCO WA
99301-3393
US

V. Phone/Fax

Practice location:
  • Phone: 509-792-1041
  • Fax: 509-792-1034
Mailing address:
  • Phone: 509-792-1041
  • Fax: 509-792-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number60795621
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70091337
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: