Provider Demographics
NPI:1952903353
Name:SNOW, KEITH WESLEY (SUDPT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WESLEY
Last Name:SNOW
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 OKANOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2970
Mailing Address - Country:US
Mailing Address - Phone:509-662-9673
Mailing Address - Fax:509-662-9441
Practice Address - Street 1:327 OKANOGAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2970
Practice Address - Country:US
Practice Address - Phone:509-662-9673
Practice Address - Fax:509-662-9441
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61109643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)