Basic Information
| Provider Information | |||||||||
| NPI: | 1235611468 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | PCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1841 MADORA AVE | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826333057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582846 | ||||||||
| FaxNumber: | 3073581144 | ||||||||
| Practice Location | |||||||||
| Address1: | 1841 MADORA AVE | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073582846 | ||||||||
| FaxNumber: | 3073581144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2018 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | PCSW-810 | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.