Healthcare Provider Details

I. General information

NPI: 1609993344
Provider Name (Legal Business Name): PETER SNELL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 CATON WAY SW
OLYMPIA WA
98502-1105
US

IV. Provider business mailing address

2118 CATON WAY SW
OLYMPIA WA
98502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 360-339-0793
  • Fax: 360-352-3289
Mailing address:
  • Phone: 360-339-0793
  • Fax: 360-352-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRC00042021
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60117760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: