Healthcare Provider Details

I. General information

NPI: 1821703356
Provider Name (Legal Business Name): JORDAN SNAJCZUK MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MARSHALL ST
RICHMOND VA
23298-5008
US

IV. Provider business mailing address

1101 E MARSHALL ST # 980033
RICHMOND VA
23298-5008
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-3510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0139000246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: