Healthcare Provider Details

I. General information

NPI: 1992270342
Provider Name (Legal Business Name): BETTY J SNYDER LW00005585
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BERNARD ST
SPOKANE WA
99201-0206
US

IV. Provider business mailing address

200 N BERNARD ST
SPOKANE WA
99201-0206
US

V. Phone/Fax

Practice location:
  • Phone: 509-354-7946
  • Fax: 509-835-1281
Mailing address:
  • Phone: 509-354-7946
  • Fax: 509-835-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005585
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: