Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Deshika Venezio Bodhi Jackson, MSW, LSWAIC

Individual provider Social Worker · NPI 1164065108

Deshika Venezio Bodhi Jackson, MSW, LSWAIC is a Clinical Social Worker in Seattle, Washington. Qualified in 2019, 7 years ago. Licensed in Washington.

Years since qualifying
7
Licensed in
WA
In the registry since
2019
Specialties on file
3
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.

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Practice location Address checks out

611 12th Ave S
Seattle, WA 98144-2007
Phone: (206) 324-9360
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 60997028 (WA)
Clinical Social Worker Taxonomy 1041C0700X · Licence SWI.LW.61395765 (WA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence CDPT.CO.70090832 (WA)

Record details

NPI number1164065108
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSW , LSWAIC
Sole proprietorNo
NPI enumeratedOctober 22, 2019
Last updated in NPPESJuly 28, 2026
Certification dateJuly 28, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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