Healthcare Provider Details

I. General information

NPI: 1407190127
Provider Name (Legal Business Name): ASHLEY MARIE SNYDER APSW, SACIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY ROSENBERG

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203 AUTUMN LEAF LANE APT. 389
MADISON WI
53704
US

IV. Provider business mailing address

5203 AUTUMN LEAF LANE APT. 389
MADISON WI
53704
US

V. Phone/Fax

Practice location:
  • Phone: 920-264-4769
  • Fax:
Mailing address:
  • Phone: 920-264-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128778-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: