Healthcare Provider Details

I. General information

NPI: 1619479300
Provider Name (Legal Business Name): KATHERINE VERONICA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 ROCKSIDE WOODS BLVD N STE 305
INDEPENDENCE OH
44131-2343
US

IV. Provider business mailing address

9907 NICHOLAS AVE
CLEVELAND OH
44102-3628
US

V. Phone/Fax

Practice location:
  • Phone: 216-403-8869
  • Fax:
Mailing address:
  • Phone: 216-403-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1500586
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: