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General NPI Number Information
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NPI Number | 1639470875
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Entity Type | Individual
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Provider Name | JENNIFER RENEE RIVERS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 1350 S KING ST STE 307
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City | HONOLULU
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State | HI
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Zip | 96814-2008
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Country | US
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Telephone | 808-809-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 204B MARINE BARRACKS WAY
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City | HONOLULU
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State | HI
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Zip | 96818-5012
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Country | US
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Telephone | 904-891-5577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA8840
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12080602
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License Number State |
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