Healthcare Provider Details

I. General information

NPI: 1023603396
Provider Name (Legal Business Name): JADE ABRAXAS WAITS LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 160TH ST S STE 101
SPANAWAY WA
98387-8508
US

IV. Provider business mailing address

201 160TH ST S STE 101
SPANAWAY WA
98387-8508
US

V. Phone/Fax

Practice location:
  • Phone: 253-881-9854
  • Fax: 253-409-2622
Mailing address:
  • Phone: 253-881-9854
  • Fax: 253-409-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70020639
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: