Healthcare Provider Details

I. General information

NPI: 1346152832
Provider Name (Legal Business Name): CRISTI ANN SIDES-BONESS SWIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 MONTPELIER DR
PASCO WA
99301-6138
US

IV. Provider business mailing address

5313 MONTPELIER DR
PASCO WA
99301-6138
US

V. Phone/Fax

Practice location:
  • Phone: 509-210-1685
  • Fax:
Mailing address:
  • Phone: 509-210-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60888314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: