MEDICARE: JACIE KEIKO SHIMAMOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861362667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACIE KEIKO SHIMAMOTO

Provider Business Mailing Address
First Line	:	3410 W WHISTALKS WAY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5204
Country	:	US
Telephone Number	:	509-903-6967
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 W WHISTALKS WAY
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5204
Country	:	US
Telephone Number	:	509-903-6967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	12/01/2025

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Directions to “ JACIE KEIKO SHIMAMOTO ” Practice Location

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