Healthcare Provider Details

I. General information

NPI: 1043097298
Provider Name (Legal Business Name): SAMANTHA SNYDER PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10857 TRADERS PKWY
FOUNTAIN CO
80817-7270
US

IV. Provider business mailing address

10857 TRADERS PKWY
FOUNTAIN CO
80817-7270
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-9277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY0005961
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: