Provider Demographics
NPI:1215206701
Name:SNYDER, MICHAEL DUANE
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DUANE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:KISSEL-NIELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CACD II
Mailing Address - Street 1:14600 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5442
Mailing Address - Country:US
Mailing Address - Phone:503-645-9581
Mailing Address - Fax:
Practice Address - Street 1:17070 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4960
Practice Address - Country:US
Practice Address - Phone:503-594-1772
Practice Address - Fax:503-594-1773
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)