Provider Demographics
NPI:1730859117
Name:MAKOVSKY, JESSICA K (LICSW, MHP, CMHS)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:K
Last Name:MAKOVSKY
Suffix:
Gender:F
Credentials:LICSW, MHP, CMHS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:K
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 6142
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:509-593-8777
Mailing Address - Fax:
Practice Address - Street 1:5219 W CLEARWATER AVE STE 13
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1980
Practice Address - Country:US
Practice Address - Phone:509-593-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2024-07-25
Deactivation Date:2024-07-17
Deactivation Code:
Reactivation Date:2024-07-24
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WALW61448236101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health