Healthcare Provider Details

I. General information

NPI: 1992018287
Provider Name (Legal Business Name): JENNIFER M SNYDER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15838 FOUNTAIN PLAZA DR STE A
CHESTERFIELD MO
63017-7469
US

IV. Provider business mailing address

660 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8512
US

V. Phone/Fax

Practice location:
  • Phone: 636-484-5220
  • Fax: 636-484-5221
Mailing address:
  • Phone: 314-448-3791
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011025417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: