Healthcare Provider Details

I. General information

NPI: 1487648168
Provider Name (Legal Business Name): JANNA LEA SNYDER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

500 W FORT ST
BOISE ID
83702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1029
Mailing address:
  • Phone: 208-422-1111
  • Fax: 208-422-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1059
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: