Healthcare Provider Details

I. General information

NPI: 1194992990
Provider Name (Legal Business Name): LAURA B SNELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 CHALAN PALOSYO
AGANA HEIGHTS GU
96910-6427
US

IV. Provider business mailing address

PO BOX 5203
HAGATNA GU
96932-8660
US

V. Phone/Fax

Practice location:
  • Phone: 508-801-9725
  • Fax:
Mailing address:
  • Phone: 508-801-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2008006397
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: