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General NPI Number Information
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NPI Number | 1194366237
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Entity Type | Individual
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Provider Name | CODI L SNYDER
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Gender | Female
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 9083 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6462
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Country | US
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Telephone | 440-255-0678
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Fax | 440-255-6348
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Provider Business Mailing Address
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Address Line | 109 S POPLAR ST APT 7-1
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City | JEFFERSON
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State | OH
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Zip | 44047-1354
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Country | US
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Telephone | 440-813-3164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190383
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License Number State | OH
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