Healthcare Provider Details

I. General information

NPI: 1053230482
Provider Name (Legal Business Name): ROSE SNYDER EDM PSYD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 WILLAMETTE FALLS DR STE 220
WEST LINN OR
97068-4655
US

IV. Provider business mailing address

1880 WILLAMETTE FALLS DR STE 220
WEST LINN OR
97068-4655
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-0987
  • Fax:
Mailing address:
  • Phone: 510-847-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE SNYDER
Title or Position: CLINICAL DIRECTOR
Credential: EDM, PSYD
Phone: 510-847-0987