Healthcare Provider Details

I. General information

NPI: 1366973893
Provider Name (Legal Business Name): MERCEDES SNODGRASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 PARK ST
BEDFORD VA
24523-2137
US

IV. Provider business mailing address

1105 PARK ST
BEDFORD VA
24523-2137
US

V. Phone/Fax

Practice location:
  • Phone: 540-875-7810
  • Fax:
Mailing address:
  • Phone: 540-875-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: