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6314 19th St W Ste 7 Fircrest WA 98466-6223 | |
| (601) 207-8735 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 6314 19th St W Ste 7, Fircrest, Washington |
| Authorized Official Name and Position | Michelle N Jaquish (SOLE OWNER) |
| Authorized Official Contact | 5416266356 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6314 19th St W Ste 7 Fircrest WA 98466-6223 Ph: (601) 207-8735 | 6314 19th St W Ste 7 Fircrest WA 98466-6223 Ph: (601) 207-8735 |
| NPI Number | 1831824424 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 01/13/2025 |
| Certification Date | 01/13/2025 |
| Medicare PECOS PAC ID | 2961887872 |
|---|---|
| Medicare Enrollment ID | O20220913003161 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831824424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michelle N Jaquish |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174091110 PECOS PAC ID: 8729476031 Enrollment ID: I20211019000965 |
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