Provider Demographics
NPI:1073564449
Name:SNELLMAN, LYNDA M
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:SNELLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STERN RD
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679-9607
Mailing Address - Country:US
Mailing Address - Phone:937-386-1379
Mailing Address - Fax:937-386-0129
Practice Address - Street 1:5400 DUPONT CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-9607
Practice Address - Country:US
Practice Address - Phone:513-576-7700
Practice Address - Fax:513-576-1020
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSN2027871Medicare PIN
OHSN2027872Medicare PIN