MEDICARE: MARY SNYDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104156603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SNYDER

Provider Business Mailing Address
First Line	:	870 PRAIRIE LILY LN
Second Line	:
City	:	DAVIS JUNCTION
State	:	IL
Zip	:	61020-9450
Country	:	US
Telephone Number	:	815-519-4937
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S 4TH ST
Second Line	:
City	:	OREGON
State	:	IL
Zip	:	61061-1609
Country	:	US
Telephone Number	:	815-732-3157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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Directions to “ MARY SNYDER ” Practice Location

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