Healthcare Provider Details

I. General information

NPI: 1801190624
Provider Name (Legal Business Name): KIMBERLY ANN SNYDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY CAMPBELL PSY.D.

II. Dates (important events)

Enumeration Date: 01/08/2011
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 W INDIAN SCHOOL ROAD E-101
AVONDALE AZ
85392-9502
US

IV. Provider business mailing address

PO BOX 284
LITCHFIELD PARK AZ
85340-4908
US

V. Phone/Fax

Practice location:
  • Phone: 602-857-9797
  • Fax: 602-745-4997
Mailing address:
  • Phone: 602-857-9797
  • Fax: 623-745-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-004017
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4017
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: