Healthcare Provider Details

I. General information

NPI: 1154392934
Provider Name (Legal Business Name): SANDRA SNOWDEN KELLOGG LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 5TH ST
SAINT CLOUD FL
34769-3024
US

IV. Provider business mailing address

701 E 5TH ST
SAINT CLOUD FL
34769-3024
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-9130
  • Fax:
Mailing address:
  • Phone: 407-891-9130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: