Healthcare Provider Details

I. General information

NPI: 1447114251
Provider Name (Legal Business Name): AMBER-ROSE SNOWDEN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S PARK AVE STE 2
HERRIN IL
62948-4134
US

IV. Provider business mailing address

3113 WEAVER RD
HERRIN IL
62948-6142
US

V. Phone/Fax

Practice location:
  • Phone: 618-515-5738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.028619
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: