Healthcare Provider Details

I. General information

NPI: 1952060949
Provider Name (Legal Business Name): KATELYNN SNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CENTRAL ST
BETHALTO IL
62010-1447
US

IV. Provider business mailing address

101 CHITTYVILLE RD
HERRIN IL
62948-3552
US

V. Phone/Fax

Practice location:
  • Phone: 618-554-2032
  • Fax:
Mailing address:
  • Phone: 618-967-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.026717
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: