1609993344 NPI number — PETER SNELL MSW

Table of content: PETER SNELL MSW (NPI 1609993344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609993344 NPI number — PETER SNELL MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNELL
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609993344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 HENDERSON BLVD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-4245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-339-2988
Provider Business Mailing Address Fax Number:
360-596-9027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2530 NE KRESKY AVE
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-339-2988
Provider Business Practice Location Address Fax Number:
360-596-9027
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  RC00042021 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LW60117760 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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