Provider Demographics
NPI:1194188664
Name:SNIDER, SARAH JOY (LPC, CADC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JOY
Last Name:SNIDER
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 HEATHER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6685
Mailing Address - Country:US
Mailing Address - Phone:630-921-3838
Mailing Address - Fax:
Practice Address - Street 1:143 HEATHER GLEN DRIVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6685
Practice Address - Country:US
Practice Address - Phone:630-921-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30980101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474579189001Medicaid