# JACKY JAEOK KIM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1790506665
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 24-QMHP-R-3205 | OR | — |
| 1041C0700X | Clinical Social Worker | L17503 | OR | — |
| 1041C0700X | Clinical Social Worker | SC61561577 | WA | Yes |
| 1041C0700X | Clinical Social Worker | SWI.LW.70016961 | WA | Yes |

## Other

- **Enumeration date:** 10/22/2024
- **Last updated:** 06/23/2026