Healthcare Provider Details

I. General information

NPI: 1326720319
Provider Name (Legal Business Name): PORTIA JANE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE BLDG 2284
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S 5TH AVE BLDG 2284
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 708-743-1381
  • Fax: 708-202-4954
Mailing address:
  • Phone: 708-743-1381
  • Fax: 708-202-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: