Healthcare Provider Details

I. General information

NPI: 1790552982
Provider Name (Legal Business Name): CAROLYN SNYDER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 MAPLE ST
SAN MATEO CA
94402-3004
US

IV. Provider business mailing address

1416 MAPLE ST
SAN MATEO CA
94402-3004
US

V. Phone/Fax

Practice location:
  • Phone: 650-269-0736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP11895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: