Individual provider Active NPI

Grace Jacobs, LICSW

  • Social Worker
  • Seattle, WA
National Provider Identifier
1689117301
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
LW60696535 Issued in WA
Practice address
1202 E Pine St
Seattle, WA 98122-3929
Phone
(206) 705-8595
Fax
(206) 374-2570
NPI assigned
Nov 29, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LW60696535 WA
Social Worker 104100000X LW60696535 WA Primary

Addresses

Primary practice location

1202 E Pine St
Seattle, WA 98122-3929

Mailing address

1202 E Pine St
Seattle, WA 98122-3929
Phone (206) 705-8595

Other identifiers 1

IdentifierTypeStateIssuer
2071895MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161214000724 WA Practitioner - Clinical Social Worker 2466732268 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LW60696535WAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Care Washington PLLC CurrentSince Nov 28, 2016 Accepting new patients
Reflect PLLC CurrentSince Jul 3, 2020 Accepting new patients
Optum Care Washington PLLC CurrentSince Nov 28, 2016 Accepting new patients

Locations

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

15418 Main St
Mill Creek, WA 98012
Phone (425) 225-8000

226 Summit Ave E
Seattle, WA 98102
Phone (206) 322-2900

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1689117301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 E PINE ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981223929",
            "telephone_number": "206-705-8595",
            "fax_number": "206-374-2570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E PINE ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981223929",
            "telephone_number": "206-705-8595",
            "fax_number": "206-374-2570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "GRACE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-29",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60696535",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW60696535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2071895",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.