Provider Demographics
NPI:1407255144
Name:RIVERA, DANETTE
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 E SPANGLE WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:SPANGLE
Mailing Address - State:WA
Mailing Address - Zip Code:99031-9703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3025 E SPANGLE WAVERLY RD
Practice Address - Street 2:
Practice Address - City:SPANGLE
Practice Address - State:WA
Practice Address - Zip Code:99031-9703
Practice Address - Country:US
Practice Address - Phone:423-596-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WASCS610014451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker