Healthcare Provider Details

I. General information

NPI: 1689117301
Provider Name (Legal Business Name): GRACE JACOBS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E PINE ST
SEATTLE WA
98122-3929
US

IV. Provider business mailing address

1202 E PINE ST
SEATTLE WA
98122-3929
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-8595
  • Fax: 206-374-2570
Mailing address:
  • Phone: 206-705-8595
  • Fax: 206-374-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW60696535
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60696535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: