Healthcare Provider Details

I. General information

NPI: 1104215524
Provider Name (Legal Business Name): KAMEYCE JAVELL RIVERS-LEADER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KAMEYCE JAVELL RIVERS- LEADER

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 42ND AVE SW APT 320
SEATTLE WA
98116-4620
US

IV. Provider business mailing address

6232 MARYMERE RD SW LOT 10
PORT ORCHARD WA
98367-6026
US

V. Phone/Fax

Practice location:
  • Phone: 253-881-9854
  • Fax: 253-409-2622
Mailing address:
  • Phone: 580-730-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70143169
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: