Healthcare Provider Details

I. General information

NPI: 1326683541
Provider Name (Legal Business Name): SYDNEY SNYDER MS, LPC, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 N PROSPECT AVE
MILWAUKEE WI
53202-3017
US

IV. Provider business mailing address

1429 N PROSPECT AVE
MILWAUKEE WI
53202-3017
US

V. Phone/Fax

Practice location:
  • Phone: 414-212-5282
  • Fax: 414-332-2368
Mailing address:
  • Phone: 414-212-5282
  • Fax: 414-332-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19016-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10202-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: