Healthcare Provider Details

I. General information

NPI: 1447915731
Provider Name (Legal Business Name): ASHLEY SNYDER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 ROWLAND RD
MORA MN
55051-7119
US

IV. Provider business mailing address

2031 ROWLAND RD
MORA MN
55051-7119
US

V. Phone/Fax

Practice location:
  • Phone: 320-364-1300
  • Fax:
Mailing address:
  • Phone: 320-364-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303840
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: