Provider Demographics
NPI:1295943496
Name:JACKSON, CASEY (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:CASEY
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1124 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1132
Mailing Address - Country:US
Mailing Address - Phone:509-981-9851
Mailing Address - Fax:
Practice Address - Street 1:1124 W RIVERSIDE AVE
Practice Address - Street 2:SUITE LL2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1132
Practice Address - Country:US
Practice Address - Phone:509-981-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001054101YA0400X
WALW000044761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical