Jack Wyatt Beam, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LW70069003 Issued in WA

Practice address

17018 15TH Ave NE
Shoreline, WA 98155-5137

Phone

(206) 362-7282

NPI assigned

Jan 3, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1396406245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555137",
            "telephone_number": "206-362-7282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555137",
            "telephone_number": "206-362-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAM",
        "first_name": "JACK",
        "middle_name": "WYATT",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-03",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW70069003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.