Healthcare Provider Details

I. General information

NPI: 1962456608
Provider Name (Legal Business Name): TODD ALISON SNYDER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 BROADWAY
MERRILLVILLE IN
46410-7039
US

IV. Provider business mailing address

350 MARILYN RD
BURNS HARBOR IN
46304-9621
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-6220
  • Fax: 219-736-6227
Mailing address:
  • Phone: 219-787-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: