MEDICARE: AMY JACK CPS

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

General Provider Information

NPI Number	:	1760333272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JACK CPS

Provider Business Mailing Address
First Line	:	6400 SOUTHCENTER BLVD
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4238 AUBURN WAY N
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-1311
Country	:	US
Telephone Number	:	206-901-2000
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ AMY JACK CPS” Practice Location

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