Provider Demographics
NPI:1811534845
Name:GREGORY, JASMINE (LICSW)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:ILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSWAIC
Mailing Address - Street 1:311 MARTIN LUTHER KING JR. WAY
Mailing Address - Street 2:MS:315-C2-PHP
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-403-1418
Mailing Address - Fax:
Practice Address - Street 1:311 MARTIN LUTHER KING JR. WAY
Practice Address - Street 2:MS:315-C2-PHP
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-403-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609567851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical