Healthcare Provider Details

I. General information

NPI: 1740877729
Provider Name (Legal Business Name): KATHERINE SNYDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 W ARMITAGE AVE
CHICAGO IL
60647-5935
US

IV. Provider business mailing address

3046 W ARMITAGE AVE
CHICAGO IL
60647-5935
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-8042
  • Fax:
Mailing address:
  • Phone: 312-600-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.014696
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: