Healthcare Provider Details

I. General information

NPI: 1285163501
Provider Name (Legal Business Name): MICHELLE LOUISE SNYDER BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 TECHNICAL DR
MIAMISBURG OH
45342-6107
US

IV. Provider business mailing address

1907 STONEWOOD DR
BEAVERCREEK OH
45432-4004
US

V. Phone/Fax

Practice location:
  • Phone: 937-847-8750
  • Fax:
Mailing address:
  • Phone: 937-620-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00923
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: