Healthcare Provider Details

I. General information

NPI: 1447033915
Provider Name (Legal Business Name): NIKKI MICHELLE SNYDER LSW, DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI MICHELLE KOYSTE LSW, DSW

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PENN AVE STE 205-206
WYOMISSING PA
19610-2100
US

IV. Provider business mailing address

1235 PENN AVE STE 205-206
WYOMISSING PA
19610-2100
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4963
  • Fax: 610-378-5403
Mailing address:
  • Phone: 610-374-4963
  • Fax: 610-378-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131697
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: