=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609993344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER SNELL MSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2118 CATON WAY SW
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98502-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-339-0793
-----------------------------------------------------
Fax | 360-352-3289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2118 CATON WAY SW
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98502-1105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-339-0793
-----------------------------------------------------
Fax | 360-352-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | RC00042021
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW60117760
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------