MEDICARE: SYDNEY SNYDER MS, LPC, SAC-IT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	19016-130	WI
2	101YM0800X	Mental Health Counselor	10202-125	WI

General Provider Information

NPI Number	:	1326683541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY SNYDER MS, LPC, SAC-IT

Provider Business Mailing Address
First Line	:	1429 N PROSPECT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3017
Country	:	US
Telephone Number	:	414-212-5282
Fax Number	:	414-332-2368

Provider Business Practice Location Address
First Line	:	1429 N PROSPECT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3017
Country	:	US
Telephone Number	:	414-212-5282
Fax Number	:	414-332-2368

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

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	02/15/2023

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