Healthcare Provider Details

I. General information

NPI: 1053662825
Provider Name (Legal Business Name): KATY MARIE SNIDER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 WOODBERRY WAY
WINFIELD WV
25213-7778
US

IV. Provider business mailing address

431 WOODBERRY WAY
WINFIELD WV
25213-7778
US

V. Phone/Fax

Practice location:
  • Phone: 717-636-0258
  • Fax:
Mailing address:
  • Phone: 717-636-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL009445
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-1564
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: