Provider Demographics
NPI:1235564485
Name:SNYDER, MARY LYDIA
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYDIA
Last Name:SNYDER
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 1:10276 HAZELGREEN RD NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9693
Mailing Address - Country:US
Mailing Address - Phone:503-510-0634
Mailing Address - Fax:
Practice Address - Street 1:10276 HAZELGREEN RD NE
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-9693
Practice Address - Country:US
Practice Address - Phone:503-510-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst