Healthcare Provider Details

I. General information

NPI: 1730629791
Provider Name (Legal Business Name): DANE SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 E PALATINE RD SUITE 250
PALATINE IL
60074-5500
US

IV. Provider business mailing address

328 CHARLOTTE CT UNIT 8
SCHAUMBURG IL
60193-7321
US

V. Phone/Fax

Practice location:
  • Phone: 708-712-5254
  • Fax:
Mailing address:
  • Phone: 708-712-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178012437
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: