Provider Demographics
NPI:1194591412
Name:SHNEYDER, ESTELLA STACY (CB61492784)
Entity type:Individual
Prefix:MISS
First Name:ESTELLA
Middle Name:STACY
Last Name:SHNEYDER
Suffix:
Gender:F
Credentials:CB61492784
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SW 363RD PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-7299
Mailing Address - Country:US
Mailing Address - Phone:253-444-7378
Mailing Address - Fax:
Practice Address - Street 1:812 SW 363RD PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-7299
Practice Address - Country:US
Practice Address - Phone:253-444-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61492784106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician