Healthcare Provider Details

I. General information

NPI: 1407462054
Provider Name (Legal Business Name): KATELYNN MARIE SNIECINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LOS ALTOS PKWY STE 109
SPARKS NV
89436-7754
US

IV. Provider business mailing address

2442 WABASH CIR
SPARKS NV
89434-8842
US

V. Phone/Fax

Practice location:
  • Phone: 775-996-3890
  • Fax:
Mailing address:
  • Phone: 541-613-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: