Healthcare Provider Details

I. General information

NPI: 1871106450
Provider Name (Legal Business Name): LISA ELAINE SNYDER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ELAINE DURRANT CF-SLP

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MINERVA ST
TIFFIN OH
44883-1560
US

IV. Provider business mailing address

130 MINERVA ST
TIFFIN OH
44883-1560
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-1566
  • Fax:
Mailing address:
  • Phone: 419-447-1566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.14080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: