Provider Demographics
NPI:1053662825
Name:SNIDER, KATY MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:MARIE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WOODBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-7778
Mailing Address - Country:US
Mailing Address - Phone:717-636-0258
Mailing Address - Fax:
Practice Address - Street 1:431 WOODBERRY WAY
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7778
Practice Address - Country:US
Practice Address - Phone:717-636-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009445235Z00000X
WVSLP-1564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist