Individual
DESHIKA VENEZIO BODHI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSWAIC
Contact information
Practice address
611 12TH AVE S, SEATTLE, WA 98144-2007
(206) 324-9360
Mailing address
611 12TH AVE S, SEATTLE, WA 98144-2007
(206) 324-9360
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
60997028
WA
1041C0700X
Clinical Social Worker
SWI.LW.61395765
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60997028
DOH LSWAIC CREDENTIAL
WA
Enumeration date
10/22/2019
Last updated
05/13/2026
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