Provider Demographics
NPI:1093931156
Name:SNYDER, JUDY KAY (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:KAY
Last Name:SNYDER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:KAY
Other - Last Name:MCKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:9013 W 48TH TER
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-1219
Mailing Address - Country:US
Mailing Address - Phone:913-634-7388
Mailing Address - Fax:
Practice Address - Street 1:10551 BARKLEY ST
Practice Address - Street 2:SUITE 315
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1812
Practice Address - Country:US
Practice Address - Phone:913-317-8332
Practice Address - Fax:913-317-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16501041C0700X
KS14-473382-12163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse