Provider Demographics
NPI:1619646189
Name:MYERS, JACQUELINE (MSW, SUDPT, MHP, CC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW, SUDPT, MHP, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3609
Practice Address - Country:US
Practice Address - Phone:509-570-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61253766101YA0400X
106E00000X
WACL60831073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst