Healthcare Provider Details

I. General information

NPI: 1982951430
Provider Name (Legal Business Name): ANDREA JILL SNYDER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 WINDHAM CT STE 2
BOARDMAN OH
44512-5034
US

IV. Provider business mailing address

PO BOX 5545
POLAND OH
44514-0545
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-1354
  • Fax: 330-953-1364
Mailing address:
  • Phone: 330-953-1354
  • Fax: 330-953-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6923
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: