| Doctor Name: | MRS. JENNIFER JEWLYNN RIVERA |
| NPI Number: | 1316082530 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RC00056567 |
| Business Practice Address: | 42 Klondike Rd Republic, WA - 991669701 |
| Business Phone Number: | 5097753341 |
| Business Fax Number: | 5097758906 |
| Mailing Address: | Po Box 907, REPUBLIC |
| State: | WA |
| Postal Code: | 991660907 |
| Phone Number: | 5097753583 |
| Fax Number: | |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | RC00056567 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |