MEDICARE: DR. JAMES V SNOWDEN PH D

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	103TC0700X	Clinical Psychologist	00565	IA
2	103T00000X	Psychologist	00565	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104800150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES V SNOWDEN PH D

Provider Business Mailing Address
First Line	:	401 DOUGLAS ST STE 504
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51101-1471
Country	:	US
Telephone Number	:	712-258-1000
Fax Number	:	712-252-1100

Provider Business Practice Location Address
First Line	:	401 DOUGLAS STREET
Second Line	:	SUITE 504
City	:	SIOUX CITY
State	:	IA
Zip	:	51101-1471
Country	:	US
Telephone Number	:	712-258-1000
Fax Number	:	712-252-1100

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	08/01/2021

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