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NPI Code Detail

MEDICARE: CHARLES RUSSELL SNYDER II CDCA

MEDICARE: CHARLES RUSSELL SNYDER II CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor130482OH

General Provider Information

NPI Number : 1225553167
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES RUSSELL SNYDER II CDCA
Provider Business Mailing Address
First Line : 3250 SEEMAN ST SW
Second Line :
City : EAST SPARTA
State : OH
Zip : 44626-9718
Country : US
Telephone Number : 330-268-6150
Fax Number :
Provider Business Practice Location Address
First Line : 15 FREDERICK AVE
Second Line :
City : AKRON
State : OH
Zip : 44310-2904
Country : US
Telephone Number : 330-996-7730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2017
Last Update Date : 12/14/2025

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