Healthcare Provider Details

I. General information

NPI: 1295351054
Provider Name (Legal Business Name): LISETTE LORRAINE SNYDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 W PACIFIC DR
AMERICAN FORK UT
84003-1406
US

IV. Provider business mailing address

1472 N 350 E
OREM UT
84057-2619
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-4084
  • Fax:
Mailing address:
  • Phone: 801-634-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14133296-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: