Provider Demographics
NPI:1235611468
Name:SNYDER, JESSICA RENEE (PCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 MADORA AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3057
Mailing Address - Country:US
Mailing Address - Phone:307-358-2846
Mailing Address - Fax:307-358-1144
Practice Address - Street 1:2202 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3559
Practice Address - Country:US
Practice Address - Phone:402-475-5161
Practice Address - Fax:402-799-1055
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-8101041C0700X
NE22931041C0700X
NE3472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical