Provider Demographics
NPI:1316510530
Name:SNYDER, NICOLE ROSE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:SNYDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1942
Mailing Address - Country:US
Mailing Address - Phone:316-209-0120
Mailing Address - Fax:
Practice Address - Street 1:633 E 63RD ST STE 230
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3331
Practice Address - Country:US
Practice Address - Phone:316-209-0120
Practice Address - Fax:316-932-1556
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019043835101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor