Provider Demographics
NPI:1598655086
Name:EASTSIDE RIVERS WELLNESS PLLC
Entity type:Organization
Organization Name:EASTSIDE RIVERS WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALOME
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-883-6049
Mailing Address - Street 1:11410 NE 124TH ST # 574
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4305
Mailing Address - Country:US
Mailing Address - Phone:206-883-6049
Mailing Address - Fax:
Practice Address - Street 1:16125 JUANITA WOODINVILLE WAY NE UNIT 901
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-9431
Practice Address - Country:US
Practice Address - Phone:206-883-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty