Healthcare Provider Details

I. General information

NPI: 1013240712
Provider Name (Legal Business Name): BENJAMIN SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2009
Last Update Date: 09/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 W 97TH ST
OVERLAND PARK KS
66212-4014
US

IV. Provider business mailing address

15364 S DARNELL ST
OLATHE KS
66062-3354
US

V. Phone/Fax

Practice location:
  • Phone: 913-538-1722
  • Fax:
Mailing address:
  • Phone: 785-979-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7596
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: