Healthcare Provider Details

I. General information

NPI: 1649957192
Provider Name (Legal Business Name): SIERRA SNAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N 2ND ST
MARSHALL IL
62441-1010
US

IV. Provider business mailing address

7841 N STATE HIGHWAY 1
WEST UNION IL
62477-2023
US

V. Phone/Fax

Practice location:
  • Phone: 217-826-2361
  • Fax:
Mailing address:
  • Phone: 812-240-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: