MEDICARE: SUSAN M SNYDER LCPC

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	101YP2500X	Professional Counselor	180.006901	IL

General Provider Information

NPI Number	:	1457681702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M SNYDER LCPC

Provider Business Mailing Address
First Line	:	3385 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE D
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7702
Country	:	US
Telephone Number	:	847-414-2314
Fax Number	:	847-577-0254

Provider Business Practice Location Address
First Line	:	3385 N ARLINGTON HEIGHTS RD
Second Line	:	SUITE D
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-7702
Country	:	US
Telephone Number	:	847-414-2314
Fax Number	:	847-577-0254

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

Provider Enumeration Date	:	01/09/2010
Last Update Date	:	04/10/2010

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