Healthcare Provider Details

I. General information

NPI: 1891038931
Provider Name (Legal Business Name): LATHE EARL SNYDER L.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SOUTH. DIXE DR 220
MORAINE OH
45439
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 937-643-0398
  • Fax: 937-643-9961
Mailing address:
  • Phone: 513-741-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS0500542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: