Provider Demographics
NPI:1316407141
Name:HAN-RIVAS, JENNIFER CHERIE (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHERIE
Last Name:HAN-RIVAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHERIE
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 W SAN GORGONIO ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1458
Mailing Address - Country:US
Mailing Address - Phone:760-799-3187
Mailing Address - Fax:
Practice Address - Street 1:208 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1619
Practice Address - Country:US
Practice Address - Phone:760-799-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist