Healthcare Provider Details

I. General information

NPI: 1194231373
Provider Name (Legal Business Name): KARISSA ANN SNYDER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2017
Last Update Date: 12/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23502 LYONS AVE STE 304A
SANTA CLARITA CA
91321-2538
US

IV. Provider business mailing address

4540 HARLIN DR
SACRAMENTO CA
95826-9716
US

V. Phone/Fax

Practice location:
  • Phone: 661-702-0166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-28665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: