=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356251854
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLAN SNYDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6057 FARMERSVILLE GERMANTN PIKE
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45327-9660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-895-0045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 LORD FITZWALTER DR
-----------------------------------------------------
City | MIAMISBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45342-2067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 03319
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------