MEDICARE: MRS. KIMBERLY SNODGRASS

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	133V00000X	Registered Dietitian	872668	MI

General Provider Information

NPI Number	:	1881220606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY SNODGRASS

Provider Business Mailing Address
First Line	:	1 FORD PL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-3095
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 KERCHEVAL AVE
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3629
Country	:	US
Telephone Number	:	313-640-2651
Fax Number	:

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

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	02/18/2026

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