Provider Demographics
NPI:1134680556
Name:SNYDER O'BRIEN, MEADOW ROSE (BCBA)
Entity Type:Individual
Prefix:
First Name:MEADOW
Middle Name:ROSE
Last Name:SNYDER O'BRIEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JACKSON PLZ
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1959
Mailing Address - Country:US
Mailing Address - Phone:734-769-0505
Mailing Address - Fax:734-769-0797
Practice Address - Street 1:180 JACKSON PLZ
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1959
Practice Address - Country:US
Practice Address - Phone:734-769-0505
Practice Address - Fax:734-769-0797
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-19-35675103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst