Healthcare Provider Details

I. General information

NPI: 1548946593
Provider Name (Legal Business Name): SAMANTHA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 N LINCOLN AVE #401
CHICAGO IL
60657
US

IV. Provider business mailing address

812 CALLAHAN PLACE
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 888-870-1775
  • Fax:
Mailing address:
  • Phone: 615-200-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: