Healthcare Provider Details

I. General information

NPI: 1235611468
Provider Name (Legal Business Name): JESSICA RENEE SNYDER PCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S 11TH ST
LINCOLN NE
68502-3559
US

IV. Provider business mailing address

1841 MADORA AVE
DOUGLAS WY
82633-3057
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-5161
  • Fax: 402-799-1055
Mailing address:
  • Phone: 307-358-2846
  • Fax: 307-358-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-810
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2293
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3472
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: