Provider Demographics
NPI:1255591210
Name:SNYDER, JESSICA PAIGE (LCP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAIGE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12754 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8625
Mailing Address - Country:US
Mailing Address - Phone:785-305-1891
Mailing Address - Fax:
Practice Address - Street 1:815 SE RICE RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-2354
Practice Address - Country:US
Practice Address - Phone:785-559-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1175103TC0700X
KS1431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical