Healthcare Provider Details

I. General information

NPI: 1699001784
Provider Name (Legal Business Name): CARRIE MICHELLE SNYDER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FLORIDA AVE S STE 307
ST LOUIS PARK MN
55426-1759
US

IV. Provider business mailing address

11701 CENTRAL PARK WAY APT 1469
MAPLE GROVE MN
55369-3137
US

V. Phone/Fax

Practice location:
  • Phone: 952-544-6806
  • Fax: 952-545-0098
Mailing address:
  • Phone: 763-245-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22373
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: