Healthcare Provider Details

I. General information

NPI: 1053823781
Provider Name (Legal Business Name): NATALIE ELIZABETH SNYDERS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S SCOTT ST # 219
OAKWOOD IL
61858-6109
US

IV. Provider business mailing address

PO BOX 235
OAKWOOD IL
61858-0235
US

V. Phone/Fax

Practice location:
  • Phone: 217-354-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.010243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: