Healthcare Provider Details

I. General information

NPI: 1053025700
Provider Name (Legal Business Name): RIKKI SNOWDEN CADC I, QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 SCENIC AVE
CENTRAL POINT OR
97502-1652
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax:
Mailing address:
  • Phone: 541-535-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23-12-10975
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: