Healthcare Provider Details

I. General information

NPI: 1104800150
Provider Name (Legal Business Name): JAMES V SNOWDEN PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/01/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DOUGLAS STREET SUITE 504
SIOUX CITY IA
51101-1471
US

IV. Provider business mailing address

401 DOUGLAS ST STE 504
SIOUX CITY IA
51101-1471
US

V. Phone/Fax

Practice location:
  • Phone: 712-258-1000
  • Fax: 712-252-1100
Mailing address:
  • Phone: 712-258-1000
  • Fax: 712-252-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00565
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00565
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: