Healthcare Provider Details

I. General information

NPI: 1780251439
Provider Name (Legal Business Name): ANGEL ANN SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 11/30/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CENTER ST FRNT B
IRONTON OH
45638-1533
US

IV. Provider business mailing address

401 CENTER ST FRNT B
IRONTON OH
45638-1533
US

V. Phone/Fax

Practice location:
  • Phone: 740-479-5135
  • Fax:
Mailing address:
  • Phone: 740-479-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA174624
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: