Provider Demographics
NPI:1518796945
Name:JACO, JOHN DOUGLAS (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:JACO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 WEST RIVERSIDE AVE
Mailing Address - Street 2:SUITE 4309
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:888-420-0589
Mailing Address - Fax:
Practice Address - Street 1:19895 4TH AVE NE
Practice Address - Street 2:UNIT A
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7481
Practice Address - Country:US
Practice Address - Phone:425-658-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615235281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical