MEDICARE: JACKIE M SMITH

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	101Y00000X	Counselor	RC00055212	WA
2	1041C0700X	Clinical Social Worker	60336105	WA

General Provider Information

NPI Number	:	1053595660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE M SMITH

Provider Business Mailing Address
First Line	:	1942 CRYSTAL SPRINGS RD W
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98466-2910
Country	:	US
Telephone Number	:	920-471-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	6512 20TH STREET CT W STE B2
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6212
Country	:	US
Telephone Number	:	253-468-7899
Fax Number	:

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

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	07/21/2022

Similar Medicare Providers

1083612279 — SILVIA TINA FRADKIN ARNP
Practice Location Address:

6512 20TH STREET CT W , SUITE C
FIRCREST, WA
98466-6212

Practice Phone: 253-459-0295
Practice Fax: 253-565-5899

1902910102 — DR. LAWRENCE V. MAJOVSKI PHD
Practice Location Address:

6512 20TH STREET CT W , SUITE C
FIRCREST, WA
98466-6212

Practice Phone: 253-572-9917
Practice Fax: 253-858-4060

1558401687 — SILVIA FRADKIN ARNP PS
Practice Location Address:

6512 20TH STREET CT W STE C
FIRCREST, WA
98466-6212

Practice Phone: 253-459-0295
Practice Fax: 253-565-5899

1528306057 — FAMILY FOUNDATIONS COUNSELING
Practice Location Address:

6512 20TH STREET CT W , STE. B
FIRCREST, WA
98466-6212

Practice Phone: 253-566-5559
Practice Fax: 253-565-0274

1295073039 — KIMBERLEY LOUISE GRUENING MCNICKLE LMHC
Practice Location Address:

6512 20TH STREET CT W , SUITE B
FIRCREST, WA
98466-6212

Practice Phone: 253-566-5559
Practice Fax: 253-565-0274

1952724478 — ASHLEY SMITH MA
Practice Location Address:

6512 20TH STREET CT W STE B1
FIRCREST, WA
98466-6212

Practice Phone: 253-740-8742
Practice Fax:

Directions to “ JACKIE M SMITH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.