Healthcare Provider Details

I. General information

NPI: 1669608964
Provider Name (Legal Business Name): REBECCA BENGTSON SNYDER M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BELTRAMI AVE NW STE 200
BEMIDJI MN
56601-3053
US

IV. Provider business mailing address

619 BELTRAMI AVE NW STE 200
BEMIDJI MN
56601-3053
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-8187
  • Fax:
Mailing address:
  • Phone: 218-333-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18642
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: