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
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDPT.CO.70090832
WA
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
07/28/2026
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